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Introduction

The goal of errorless learning is for an individual with cognitive impairments to learn new skills. Using errorless learning, there is an emphasis on generating correct responses and preventing any incorrect responses from occurring. According to the principles of errorless learning, when mistakes are made, the mistakes can be learned by the individual. By avoiding incorrect responses, errorless learning promotes only correct responding.  Through repetition with the therapist, mastery is facilitated. When using errorless learning, the therapist provides specific directions and the individual must follow those exact instructions (Brown, 2012).

Theory

Based on behavioral theory developed by Skinner, an individual’s behavior is learned through feedback from the environment (Sames, 2015). The objective is for consequences in the natural environment to reinforce/increase positive behaviors and to eliminate or minimize maladaptive behaviors.  Through contact with positive consequences contingent on engaging in behaviors learned using errorless learning techniques, such appropriate behaviors are maintained.  This development of new social skills, in turn, increases social participation.

Evidence

A study found errorless learning to be a significantly effective intervention for homeless diagnosed with schizophrenia presenting with deficits in social problem-solving skills (Kern, Green, Mitchell, Kopelowicz, Mintz, Liberman, 2005) Researchers focused on three skill areas: receiving skills (identifying the presence/ absence of a problem), processing skills (generating an appropriate solution) & sending skills (effectively enacting the solution).

Case Study

Fitzroy Frederick is a 37 year old homeless man living with schizophrenia in New York City.  He was provided housing and an employment opportunity in The Fountain House, a program designed to provide assistance to individuals with mental illness. Recently, Fitzroy has become confrontational and verbally aggressive with his roommates.  He has been observed yelling, swearing, and insulting other residents in The Fountain House, and will often storm out when upset.  Fitzroy was referred to an occupational therapist at The Fountain House to address his verbally aggressive behaviors and improve his social skills.  The occupational therapist has determined Fitzroy will benefit from errorless learning techniques to address his deficits.

Intervention Plan

Problem Statement

Fitzroy demonstrates difficulty participating in social situations effectively. His limited understanding of appropriate social interactions results in hostile and aggressive outbursts when disagreeing with others.

Long Term Goals

1. Fitzroy will engage in 3 positive exchanges with a peer during a therapy session independently to improve his social participation within 4 weeks.
2. Fitzroy will utilize 1 positive solution to a social problem learned from the video demonstration with a peer independently to improve his social participation within 4 weeks.

Short Term Goals

1. Fitzroy will role play 1 positive exchange with a peer during a therapy session with verbal cueing from the therapist to improve his social participation within 2 weeks.
2. Fitzroy will identify the presence of 1 social conflict when watching a demonstration video during a therapy session to improve awareness of appropriate social interactions for social participation within 2 weeks.

Intervention Format

Group session

Setting

Fitzroy will meet with the occupational therapist in a group session at the Fountain House for 30 minutes 2x a week.

Supplies

None

Agenda

• Meet group & develop rapport through group warm up exercise (5 min)
• Engage social group session (20 minutes)
  • Present video demonstration on social interactions
  • Use errorless learning techniques to identify social conflicts
• Provide a summary of video demonstration and skills acquired (5 min)

Documentation

S: “I get so mad, I don’t know how to talk to my roommates. I just want to yell at them.”

O: Client completed a 30-minute group session utilizing a video demonstration of appropriate social interactions and errorless learning techniques. The video demonstration showed a social conflict between two peers, and the therapist modeled identification of the peer conflict. Client practiced the identification of the key problems in the social interaction presented in the video with the use of verbal cues from the therapist for 5 out of 7 opportunities.

A: Client requires multiple demonstrations to accurately identify the peer conflict, indicating poor social skills and lack of awareness of appropriate behavior.

P: Continue with errorless learning techniques to increase appropriate socialization.  Target the client’s ability to practice identification of problems and appropriate responses in social interactions. Client to see OT 2x/ weekly for 30 minutes each in group sessions.

References

Brown, C. (2012). Occupational therapy practice guidelines for adults with serious mental illness. Bethesda, MD: AOTA Press. ISBN-13: 978-1-56900-331-2

Kern, R. S., Green, M. F., Mitchell, S., Kopelowicz, A., Mintz, J., & Liberman, R. P. (2005). Extensions of errorless learning for social problem-solving deficits in schizophrenia. American Journal of Psychiatry, (3). 513.

Sames, K. M. (2015). Documenting occupational therapy practice. Upper Saddle River, NJ : Pearson Education, [2015]