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/Intro to Washing Hands
Intro to Washing Hands
Intro to Washing Hands
Intro to Washing Hands

Intro to Washing Hands

Below is a general skill sequence for the first stages of teaching learners how to wash their hands.

Where most protocols might call for immediately working on hand washing with a task analysis (TA), this skill sequence isolates component skills before working on hand washing with a TA. Strengthening these skills in isolation could—more effectively—prepare the learner for the TA that you’ll eventually teach.

How this skill area relates to your assessments!

This skill area aligns with various assessments and their respective domains, with milestone and domain codes provided for reference. Additionally, DSM-5 diagnostic criteria for Autism are included to help clinicians identify how this skill area potentially supports medical necessity in relation to the diagnosis.

VB-MAPP (Verbal Behavior Milestones Assessment and Placement Program)

  • Visual Perception/Match to Sample, VPMS 2-M, Grasps small objects with thumb, index finger, and middle finger (pincer grasp) 5 times.
  • Motor Imitation, MI 6-M, Imitates 10 actions that require selecting a specific object from an array (e.g., selects a drumstick from an array also containing a horn and a bell, and imitates an adult’s drumming).
  • Group, G 11-M, Uses the toilet and washes hands with only verbal prompts.

AFLS (Assessment of Functional Living Skills)

  • Self Management, SM19, Remains calm during hygiene and grooming routines.
  • Bathing, BT4, Regulates water temperature
  • Grooming, GR1, Turns on and off sink faucet
  • Grooming, GR2, Washes hands
  • Toileting, TL13, Washes hands after using restroom

DSM-V Diagnostic Criteria for Autism

  • A2, Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.

CDC’s Developmental Milestones

  • 30 Months, Social/Emotional Milestones, Follows simple routines when told, like helping to pick up toys when you say, “It’s clean-up time.”
  • 30 Months, Cognitive Milestones, Shows simple problem-solving skills, like standing on a small stool to reach something.
  • 30 Months, Movement/Physical Milestones, Uses hands to twist things, like turning doorknobs or unscrewing lids

Treatment Plan Goal Ideas

Treatment plan goal ideas for this particular skill area are as follows:

Learner will successfully perform three independent actions related to washing hands in contrived scenarios.

Learner will successfully perform five independent actions related to washing hands in contrived scenarios.

Learner will successfully perform ten independent actions related to washing hands in contrived scenarios.

Component Skills

Your learner may need to be fluent in these component skills first before introducing this goal/skill area. Component skills for this skill sequence may include skill areas that are fundamental to other areas. Fluency in the skill areas listed below may increase the likelihood that your learner will succeed in this skill sequence and those afterward.

Intro to Scanning Intro to Scanning Intro to Matching (Visual Perception) Intro to Matching (Visual Perception) Intro to Reinforcer/Preference ExpansionIntro to Reinforcer/Preference ExpansionImitates Actions with Preferred ItemsImitates Actions with Preferred ItemsPerforms Preferred Action with Preferred Item (LR)Performs Preferred Action with Preferred Item (LR)Imitates Actions During Familiar RoutinesImitates Actions During Familiar RoutinesPerforms Action During Familiar Routines (LR)Performs Action During Familiar Routines (LR)Imitation with Uni-Functional ToysImitation with Uni-Functional ToysPerforms Actions with Uni-Functional Toys (LR)Performs Actions with Uni-Functional Toys (LR)

Skill Possibilities

Below is a possible skill sequence for working on increasing your learner’s ability to wash their hands. Note that every learner is different and that you likely will need to tweak and vary some programming to their needs. Click the triangle icon to view the full description for each skill in the sequence/area.

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#1 Walks to the sink when asked to

How to Run

  1. Ensure that you have the attention and motivation of the learner.
  2. Ask the learner to follow you to the nearest sink (hand holding is okay too).
  3. Score correctly if the learner walks to the sink without problem behavior.
  4. Reinforce accordingly.

Additional Notes

Materials

Research/Resources

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#2 Washes hands with hand over hand

How to Run

  1. Gain the learner’s attention and motivation.
  2. Have learner complete all steps of a hand washing routine using hand-over-hand and other prompts when necessary.
  3. Score correctly if the learner gets through the process without engaging in problem behavior, tolerating the prompts.
  4. Reinforce accordingly.

Additional Notes

Materials

Research/Resources

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#3 Turns off water when asked to

How to Run

  1. Ensure that you have the attention and motivation of the learner.
  2. Ensure that you and the learner are in front of a sink with the water running.
  3. Ensure that the learner is close enough to reach the handles for the faucet (you may need a stool).
  4. Ask the learner to turn the water off.
  5. The learner should reach toward the handles/knobs and turn the water off.
  6. Reinforce accordingly.

Additional Notes

Materials

  • Sink
  • Stool (if needed)

Research/Resources

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#4 Finds and/or labels soap

How to Run

  1. Take your learner to a restroom sink.
  2. Rotate through having 3-4 different kinds of soap available to the learner (soap in a bottle, bar soap, automatic dispenser, etc.)
  3. Ensure that you have the attention and motivation of the learner.
  4. Ask the learner to find the soap.
  5. The learner should find whatever version of the soap you have presented them
  6. Reinforce accordingly.

Additional Notes

  • This acts as a component skill for using different kinds of soaps and ensures the learner knows what and where to find the different variations of dispensers.

Materials

  • Soap bottle (can be empty)
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#5 Pumps soap (bottle) one time

How to Run

  1. Ensure that you have the attention and motivation of the learner.
  2. Present a pump soap or sanitizer. (The bottle does not have to have soap in it).
  3. Ask the learner to “Get some soap.”
  4. The learner should take the soap, put their hand under the spout, and pump it.
  5. Reinforce accordingly.

Additional Notes

  • Since the soap bottle can be empty, you can run this program in a variety of settings (including their usual workspace) as you can take a bottle with you. However, you should always try to run this when you are washing hands in the natural setting as well.

Materials

  • Soap bottle (can be empty)
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#6 Uses automatic soap dispenser

How to Run

  1. Take your learner to a restroom sink that has an automatic soap dispenser.
  2. Ensure that you have the attention and motivation of the learner.
  3. Ask the learner to “Get some soap.”
  4. The learner should find the automatic soap dispenser and put their hand under the dispenser until the soap dispenses.
  5. Reinforce accordingly.

Additional Notes

Materials

  • Soap bottle (can be empty)
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#7 Turns on water when asked to

How to Run

  1. Ensure that you have the attention and motivation of the learner.
  2. Ensure that you and the learner are in front of a sink with the water off.
  3. Ensure that the learner is close enough to reach the handles for the faucet (you may need a stool).
  4. Ask the learner to turn the water on.
  5. The learner should reach toward the handles/knobs and turn the water on. Temperature does not matter.
  6. Reinforce accordingly.

Additional Notes

  • Make sure they do not burn themselves if they accidentally durn on hot water.

Materials

  • Sink
  • Stool (if needed)

Research/Resources

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#8 Dries wet sink area

How to Run

  1. Ensure that a towel or paper towel is near your learner.
  2. Bring the learner to a sink that has water spilled on the counter or faucet area.
  3. Ensure that you have the attention and motivation of the learner.
  4. Ask the learner to dry the sink.
  5. The learner should find the towel.
  6. They should dry up the wet area.
  7. They should dispose of the towel.
  8. Reinforce accordingly.

Additional Notes

  • Note that the learner does not need to have wet hands for this program. You can run this program in various settings/locations including their workspace.

Materials

  • Towel
  • Paper towel
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#9 Turns on water to reasonable temp

How to Run

  1. Ensure that you have the attention and motivation of the learner.
  2. Ensure that you and the learner are in front of a sink with the water off.
  3. Ensure that the learner is close enough to reach the handles for the faucet (you may need a stool).
  4. Ask the learner to turn the water on.
  5. The learner should reach toward the handles/knobs and turn the water on to a temperature that does not burn them.
  6. Reinforce accordingly.

Additional Notes

  • Make sure they do not burn themselves if they accidentally durn on hot water.

Materials

  • Sink
  • Stool (if needed)

Research/Resources

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#10 Turns on water to reasonable flow

How to Run

  1. Ensure that you have the attention and motivation of the learner.
  2. Ensure that you and the learner are in front of a sink with the water off.
  3. Ensure that the learner is close enough to reach the handles for the faucet (you may need a stool).
  4. Ask the learner to turn the water on.
  5. The learner should reach toward the handles/knobs and turn the water on to a reasonable flow (ensuring that the water isn’t dribbling or blasting from the spot).
  6. Reinforce accordingly.

Additional Notes

  • Make sure they do not burn themselves if they accidentally durn on hot water.

Materials

  • Sink
  • Stool (if needed)

Research/Resources

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#11 Scrubs hands

How to Run

  1. Ensure that you have the attention and motivation of the learner.
  2. Ask them to scrub their hands. “Scrub your hands!” (Their hands do not have to be wet nor do they have to have soap).
  3. The learner should rub their palms together (roughly 3 times).
  4. They should rub the back of their left hand with their right hand (roughly 3 times).
  5. They should rub the back of their right hand with their left hand (roughly 3 times).
  6. They should “flick” the excess “water”.
  7. Reinforce accordingly.

Additional Notes

  • Note that the learner does not need to have wet, soapy hands for this program as its a contrived program. You can run this program in various settings/locations including their workspace. However, you should always try to run this when you are washing hands in the natural setting as well.

Materials

  • Towel
  • Paper towel
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#12 Dries hands with towel/paper towel

How to Run

  1. Ensure that a towel or paper towel is near your learner.
  2. Ensure that you have the attention and motivation of the learner.
  3. Ask the learner to dry their hands (they do not need to be wet).
  4. The learner should find the towel.
  5. They should run the towel over the top of each hand.
  6. They should run the towel over each palm.
  7. They should run the towel between their fingers (as needed).
  8. They should put it under the water.
  9. Reinforce accordingly.

Additional Notes

  • Note that the learner does not need to have wet hands for this program. You can run this program in various settings/locations including their workspace. However, you should always try to run this when you are washing/drying hands in the natural setting as well.

Materials

  • Towel
  • Paper towel
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#13 Uses bar soap

How to Run

  1. Take your learner to a restroom sink that has bar soap.
  2. Ensure that the sink is running.
  3. Ensure that you have the attention and motivation of the learner.
  4. Ask the learner to “Get some soap.”
  5. The learner should find the bar soap and pick it up.
  6. They should put it under the water.
  7. They should rotate it in their hand 3-5 times.
  8. Reinforce accordingly.

Additional Notes

Materials

  • Soap bottle (can be empty)

Concurrent Skills

Working on these skills at the same time could help with goal mastery. Maybe your learner has mastered these skills already. Perhaps they are already listed as component skills above. That’s okay! Targeting other learning channels might help your learner.

Imitates Gross Motor ActionsImitates Gross Motor ActionsImitates Fine Motor ActionsImitates Fine Motor ActionsPerforms Gross Motor Action (LR)Performs Gross Motor Action (LR)Performs Fine Motor Actions (LR)Performs Fine Motor Actions (LR)Imitation with Multi-Functional ToysImitation with Multi-Functional ToysIntro to Toileting Intro to Toileting Intro to Wiping Intro to Wiping Labels Clean & Dirty Labels Clean & Dirty Labels Wet & Dry Labels Wet & Dry Intro to Faucets/DialsIntro to Faucets/DialsWiping After Bowel MovementsWiping After Bowel Movements

Composite Skills

These are the possible next steps for learners who have mastered, or are mastering, the skills listed above. Note that new skill areas may require fluency in other component skills not listed above. Also, you can introduce composite skill sequences prematurely to keep your learner progressing, as generativity may occur earlier than expected.

Task Analyses for Washing Hands (Coming soon!)

Follow the link below to better understand component-composite analysis.

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Research and Resources
How a component analysis can reshape the way you introduce skills to your learners

The difficulties in coming up with the right programs for your learner can be endless. Very few BCBAs know about or understand the utility in using a little thing called component analysis and how it can help them out in their goal writing. A component what?

flatrockweekly.substack.com

How a component analysis can reshape the way you introduce skills to your learners
Full Circle: A Strategy to Keep Learner Programs Moving

Here is the important, second half of my first post on component analysis. A composite is a larger skill that is produced from two or more smaller component skills. Basically, a skill made up of other skills. It's a blending of all the mastered, component skills before it.

flatrockweekly.substack.com

Full Circle: A Strategy to Keep Learner Programs Moving
  • Elizabeth R. Lorah, Shawn P. Gilroy, Philip N. Hineline, Acquisition of peer manding and listener responding in young children with autism, Research in Autism Spectrum Disorders, Volume 8, Issue 2, 2014, Pages 61-67, ISSN 1750-9467, https://doi.org/10.1016/j.rasd.2013.10.009.
  • Kaitlin G. Causin, Kristin M. Albert, Vincent J. Carbone, Emily J. Sweeney-Kerwin, The role of joint control in teaching listener responding to children with autism and other developmental disabilities, Research in Autism Spectrum Disorders, Volume 7, Issue 9, 2013, Pages 997-1011, ISSN 1750-9467, https://doi.org/10.1016/j.rasd.2013.04.011.
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Disclaimer

Consistent with ethical obligations outlined by the Behavior Analysis Certification Board (BACB), users acknowledge that goal selection/direction is the responsibility of the BCBA. Users understand that goals should be tailored to the learner while ultimately involving the input of clients/stakeholders. Users understand their ethical obligations to the client/stakeholder concerning the selection, implementation, design, and minimization of risk regarding behavior change interventions as outlined in BACB Code. As such, this skill sequence serves as a general framework for generating ideas around this particular skill area and not as an assessment or curriculum.

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