Toilet Training Evaluation Form
Teacher: ______Competency Conducted by: ______
Instructions: Use a rating scale of “+” to indicate that the skill did occur and “-” to indicate that the skill did not occur. At the end of the evaluation period, tally the total number of “+” and “-” and calculate the percentage of correct responses. The shaded areas indicate critical skills; if these skills are not observed it will result in failing the competency.
Date / Remediation Date / Re-Assessment DateArea one: Organization
All materials needed are organized and ready
Variety of potential reinforcers are available
Instructor ensures that learner is wearing regular underwear, not a diaper or pull-up
Recommendation based on previous competency:
Area two: Forcing Fluids
Instructor builds motivation to urinate by making liquids readily available/easily accessible throughout the session
If learner does not regularly consume these liquids instructor “forces fluids” by requiring the learner to drink every few minutes
Instructor discontinues forcing fluids once the learner has 20 consecutive self-initiations without an accident (unless otherwise specified)
Varies elements of teaching procedures based on unique teaching situation (score across all Areas on competency)
Area three: Dry Checks
Instructor runs dry checks every 5 minutes (unless otherwise specified)
Instructor physically prompts learner to feel his/her pants
If learner’s pants are dry instructor delivers a reinforcer and verbally praises the learner using behavior specific language
If learner’s pants are wet instructor immediately runs positive practice
Once learner starts self-initiating instructor appropriately thins the schedule for dry checks and ultimately eliminates dry checks
Area four: Scheduled Bathroom Trips
Instructor physically prompts learner to walk to bathroom every 30 minutes (unless otherwise specified) without saying anything to learner
Instructor physically prompts learner to undress and sit on toilet without saying anything to learner
Instructor models the phrase “go pee in the potty” (or something similar) once learner is seated
Date / Remediation Date / Re-Assessment Date
Instructor provides no attention and does not say anything to learner while he/she is seated
Instructor physically blocks any self-stimulatory behaviors
Instructor physically blocks any attempts to get off the toilet
If learner voids:
Instructor verbally praises learner using behavior specific language and delivers edible/tangible/social reinforcers
Instructor physically prompts learner to stand up, get dressed, flush the toilet, and walk to the sink
If learner does not void:
Instructor requires learner to stay seated on toilet for 15-20 minutes (unless otherwise specified)
At the end of this interval instructor physically prompts learner to stand up, get dressed, and leave the bathroom
Instructor does not deliver any reinforcers
Instructor discontinues scheduled trips after the learner’s first self-initiation
Area five: Self-Initiations
Instructor allows learner to get up from activity to self-initiate going to the bathroom
Instructor reinforces sign/vocal mands to go to the bathroom
Instructor appropriately fades prompts for walking to the bathroom and completing the toileting routine to increase learner’s independence
Instructor differentially reinforces voiding in the toilet following a self-initiation
Instructor appropriately thins schedule of reinforcement, especially use of tangible/edible reinforcers, over time
Area six:Sign/Vocal Mand Training
Instructor begins mand training if learner hasn’t started to mand (sign or vocal) within 1 month of self-initiating (unless otherwise specified)
Instructor allows learner to self-initiate but blocks learner just prior to toilet
Instructor uses least intrusive/most effective prompt to evoke sign/vocal mand
When learner emits sign/vocal mand instructor reinforces by allowing learner to access toilet
Over time instructor appropriately increases distance from toilet at point of prompting mand
Instructor immediately reinforces learner’s mands for “potty” emitted under the control of the MO
Area seven: Positive Practice
Positive practice is consistently implemented for all accidents
Instructor Implements Positive Practice procedures:
Instructor physically prompts learner to touch the wet spot and his/her and firmly tells the learner “you go pee in the potty” in a firm but neutral voice
Date / Remediation Date / Re-Assessment Date
Instructor physically prompts learner to walk from the spot of the accident to the bathroom at a quick pace
Instructor physically prompts learner to pull down wet clothes and sit on toilet and tells learner “you go pee in the potty” in a firm but neutral voice
Instructor immediately physically prompts learner to stand up and pull up wet clothes
Instructor physically prompts learner to walk from the bathroom back to the spot of the accident at a quick pace
Positive Practice is repeated 5 times (unless otherwise specified)
After the 5th time, the instructor allows the learner to void additional urine in the toilet (if necessary) then physically prompts the learner to take off his/her wet clothes and change into dry clothes
Once in dry clothes, the instructor requires the learner to dispose of wet clothes (e.g., put in plastic bag and put bag in cubby) and return to the spot of the accident to clean up
Instructor does not provide any additional attention (e.g., eye contact, talking) or reinforcement throughout procedure
Instructor maintains composure throughout procedure
Area eight: Problem Behavior Management
Maintains composure during behavior reduction procedures
During forcing fluids, dry checks, scheduled bathroom trips, and self-initiations:
Instructor treats according to the learner’s BRP (i.e., by antecedent or punishment by topography)
If learner’s BRP doesn’t specify treatment for self-injurious or aggressive behaviors, instructor physically blocks attempts at these
During positive practice:
Instructor ignores problem behavior such as crying, whining, etc.
Instructor physically blocks attempts at other problem behaviors such as flopping/bolting, aggressions, self-injury, etc.
Instructor does NOT interrupt positive practice to implement other learner-specific punishment procedures
If “punishment induced” problem behavior continues following the completion of positive practice instructor treats according to the learner’s BRP
Area nine: Data Collection
Potty training data are accurately recorded for scheduled trips (e.g., time of trip, if the learner voided or not), accidents, and self-initiations (80% IOA)
ABC data are accurately recorded (80% IOA)
NOTE: no ABC data are recorded for problem behavior that occurs during the positive practice procedure
Potty training data are appropriately graphed and up to date
Date / Correct
(+) / Errors
(-) / % Correct / Pass/Fail
Initial Assessment
Remediation
Re-Assessment
Impressions: ______
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Targets:
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Developed by the Staff of the Carbone Clinic. May be copied and distributedwith proper attribution. 1