Evidence-Based RT Treatment Protocol Assignment

Savannah Heller

RECTH 6520

Dr. Rhonda Nelson

March 2, 2023
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I. Treatment Modality
Drama and video modeling to instruct social skills on dating and interpersonal relationships.
II. Rationale
According to the Diagnostic and Statistical Manual, fifth edition, a person with Autism
Spectrum Disorder (ASD) has deficits in the following areas: social communication,
interactions, and at least two of the four types of restricted repetitive behaviors. Social
communication deficits may impair a person's ability to maintain normal reciprocal
conversations and share emotions or personal information. Individuals with ASD frequently
demonstrate a lack of skill in initiating and maintaining social interaction with peers.
Additionally, individuals may have difficulty with non-verbal communication, such as
understanding hand gestures or satirical communication. People with ASD may also struggle
to maintain and understand relationship norms, adjust their behaviors to fit social contexts,
and make friends (American Psychiatric Association, 2022)
These skill areas are critical for developing and maintaining interpersonal relationships
with a person of interest. Thus, overcoming these difficulties to develop healthy dating and
relationship skills is vital in this population. According to research by Mogavero et al., (2020)
people with ASD show the same interest in relationships as others. Still, they frequently
indicate not knowing the crucial information to be successful at meeting people,
maintaining reciprocal conversations, and navigating specific nuances of a romantic
relationship. Developing the skills to become successful at initiating communication,
understanding appropriate social norms, sharing, and receiving emotions, and maintaining
healthy boundaries and open communication within a relationship is crucial for one's self-
efficacy in relationship skills. (Mogavero, 2020) This program would provide activity-based
experiences that enable individuals with ASD to practice and learn skills to engage in
interpersonal relationships safely.
III. Referrals
Clients with ASD aged 17X to 30X may be referred to this program if they are able to
maintain behavior that is not disruptive to the group process for 45 minutes. Individuals
who exhibit persistent disruptive, destructive, or inappropriate behaviors may benefit from
similar activities in an individual setting. Clients will be referred to the social skills
development program if they demonstrate the following:
1. Difficulty listening, expressing, and coping with the emotions of others and self.
2. Expressed interest in an interpersonal relationship.
3. Lack of reciprocal communication skills.
IV. Risk Management
Clients will not be included in this program if they demonstrate inappropriate behaviors
toward others, as this would not facilitate a safe environment for all other clients. Clients
will not be included in the group if they display self-harm or aggressive or destructive
behaviors to keep the group safe and productive.
V. Structure Criteria
Clients will meet as a group twice a week for 45 minutes each session in the community
center over the course of four consecutive weeks (8 sessions total). This program is designed
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for a group of 4-12 people. Depending on the group size, a ratio of 4:1 participant to staff
will be utilized, and additional staff members will be needed for behavioral assistance and
activity processing. The group will be held in a meeting room with enough space to walk
around for activities. The different program modules will address and continue to assess the
following areas of social skills:
 Intimacy
 Disagreements
 Connections
 Conflict and conflict resolution
 Emotional experiences
 Expressing emotions

These areas will be assessed at the beginning and the end of the program through the
Interpersonal Relationship Questionnaire. The clients will also be asked weekly to fill out a form
to indicate their level of skills obtained.

VI. Process Criteria

The recreational therapist will use a variety of different activities to assist in the
improvement of social communication, understanding, and engagement to improve self-
efficacy in relational communication of romantic competence. The methods of errorless
learning and SWAT (say, wait and watch, act out, touch and guild) will aid in the
generalization of the social skills. This means that when a mistake or inappropriate situation
occurs, it will be corrected and discussed immediately.
The therapist should open each group with check-in on emotions, followed by the
activity. Immediately following the intervention, a processing discussion will take place to
assess interest in the activity, outcomes, and content obtained during the intervention.
Throughout the four weeks, therapists will do the following:

Week Focus area Intervention / Modality

1 -Connections Drama activity focusing on connections (likes and dislikes in a partner)
-Emotional Session #1:
experience - “Dating game” drama activityactivity.
- Utilizing a scripted dating profile and the exploration of likes
and dislikes of personality traits, hobbies, lifestyles, etc.
- Each participant will have time to “play” and pick the scripted
personality they liked.
- During debrief, participants will elaborate on why they
choose who they did and make connections to personal
preferences regarding what they like in a potential partner
(ie., gender, hobbies, personality type)
Session #2:
- Participants will use a scripted drama activity to practice
initiating communication with a personality of choice. While
the other participants watch and talk after scenario plays out.
Scenarios will be about, initiating conversations, giving
compliments, facilitating boundaries, non-verbal
communication, body language cues, and reciprocal
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conversation.
- Therapists will facilitate discussion around what was
appropriate in the conversation and what was not
appropriate.
2 -Disagreements Video modeling
-Expressing Session #3 and #4:
emotions - Using relevant TV shows and movie clips that demonstrate
different forms of appropriate romantic and relationship
interactions. The group will watch multiple different
situations play out on the screen and processes the
interactions between the characters together as a group.
3 -Expressing Drama Based intervention and game activitiesactivities.
emotions Session #5
- Game activity to differentiate complex emotions such as
anger, jealousy, desire, sharing emotions, etc.
- The game will include teams that are competing against the
CTRS. The object of the game is to place the written
expression of emotion into one of the three categories:
appropriate, inappropriate, and other categories. Each
correct answer will be a point against the CTRS. This game
will utilize collaboration, communication, and teamwork.
Session #6
- Drama based activities focusing on expressing emotions.
- Dyads will be assigned, and specific scenarios will be
presented, and they must act through the scenarioscenario.
- I.e.., “Timothy has been in a relationship with Sara for 7
months, he has been getting frustrated that Sara does not
reply to his text messages for hours at a time. How should
Timothy tell Sara about this?”
- Others in group as well as the CTRS will watch the
interactions and stop and talk about different things that
come up from each scenario and drama activity
4 -Intimacy Session #7:
-Expressing - Drama activity focusing on disagreements and working
emotions through arguments.
-Connections - Each participant will be put into a silly scenario where they
disagree (the sky is blue vs. red, purple skittles vs. green
skittles) followed by a discussion from the other participants
and those in the scenario to determine if it was handled
appropriately or if they need to change their mode of
communication.
Session #8:
- Speed dating activity.
- Each person will have 5 minutes to talk to other singles in the
area and determine any interest in pursuing interpersonal
relationships. After the speed dating concludes each
participant would rate their different partners on an interest
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level (anonymously) to help facilitate connections later if both

people indicated interest in the other person.

VII. Outcome Criteria

Participants will be assessed using the Interpersonal Relationship Questionnaire- short form.
This assessment will be used prepre- and post-intervention (overall program) to monitor any
change. The participants will report on theirselftheir self-efficacy in relational skills as
demonstrated by growth in competencies in the following categories.

- Intimacy
- Disagreements
- Connections
- Conflict and conflict resolution
- Emotional experiences
- Expressing emotions

These correspond with the Program Outcomes.

The individual will:
- Demonstrate increased communication skills in initiating, sharing, and receiving
others’ emotions.
- Increase understanding of dating norms.
- Understand appropriate and inappropriate dating habits.
VIII. Credentialing
The therapist conducting this intervention will hold a national certification as a certified
therapeutic recreation specialist (CTRS) from the National Council for Therapeutic
Recreation Certification (NCTRC). Under the supervision of the CTRS, a paraprofessional may
assist in implementing the intervention. A CTRS should also possess experience working with
thewith the target populations, knowledge of autism spectrum disorder, an understanding
or the dating culture in their geographic area, and knowledge of resources for meeting and
courting singles in the area.
IX. Bibliography:

American Psychiatric Association (2022). Diagnostic and statistical manual of mental disorders (5th
ed.). https://doi.org/10.1176/appi.books.9780890425596
Anderson, A., Moore, D., Rausa, V., Finkelstein, S., Pearl, S., & Stevenson, M. (2016). A systematic
review of interventions for adults with autism spectrum disorder to promote employment.
Review Journal of Ausitms and Developmental Disorders, 4, 26-38.
https://doi.org/10.1007/s40489-016-0094-9
Callaghan, G. M. (2006). The functional idiographic assessment template (FIAT) system: For use with
interpersonally-based interventions including functional analytic psychotherapy (FAP) and FAP-
enhanced treatments. The Behavior Analyst Today, 7(3), 357–398.
https://doi.org/10.1037/h0100160 
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Evaggelinou, C. & Mpella, M. (2018). Does theatrical play promote development of social skills in
students with autism? A systematic review of the methods and measures employed in the
literature. Preschool & Primary Education, 6 (2), 96-118.
http://dx.doi.org/10.12681/ppej.16135
Parsons, M.B., Reid, D.H. & Lattimore, L.P. (2009). Increasing independence of adults with autism in
community activities: A brief, embedded teaching strategy. Behavior Analysis Practice, 40–
48. https://doi.org/10.1007/BF0339174
Mogavero, M. C., & Ko-Hsin, H. (2020). Dating and courtship behaviors among those with Autism
Spectrum Disorder.  Sexuality and Disability,  38(2), 355-364.
https://doi.org/10.1007/s11195-019-09565-8
Rhoades, O.K. (2014). Autism-centered theatre: The use of drama to improve social skills for children
on the autism spectrum.
X. A paragraph summarizing how the reviewed evidence was used to support the protocol's
design.
This four-week program utilizes three different intervention modalities: game-based
activities, drama activities, and video modeling. These activities are drawn from the body of
literature and previous studies/programs conducted with this population. According to
Rhoades (2014) drama programs can be used to improve social skills in children with ASD.
Using theater programs (drama activities) would maintain its effectiveness for young adults
in shaping behaviors and social skills. (Rhoades, 2014) Additionally, a systemic review of the
literature outlined many studies that demonstrated the effectiveness of drama activities on
the acquisition and maintenance of social behaviors in people with ASD. This review
provides examples of different means of drama play, demonstrating that it is useful for
learning social skills such as dating skills. (Evaggelinou, 2018). Video modeling is another
modality that will be used during this intervention. In asystemic review of interventions that
are useful in job skills for people with ASD, video modeling is identified as an intervention
that showed substantial benefits in social skill acquisition. (Anderson, et al. 2016). Video
modeling of behaviors has generalizable qualities and will help acquire appropriate dating
behaviors. When providing the different interventions, the therapist must use the
information provided in Parsons's article on embedded teaching strategies which were
shown to help with the generalization and acquisition of new skills in adults with ASD. These
strategies include errorless learning, and the say, wait and watch, act and touch approach.
(Parson, 2009)
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Evidence Based Treatment Protocol Grade Sheet

Section Points Possible Points Earned
Treatment Modality 5 5
Rationale 15 14
Referrals 8 7
Risk Management 10 9
Structure Criteria 10 9
Process Criteria 15 15
Outcome Criteria 10 9
Credentialing 7 6
Bibliography 10 8
Reviewed Evidence 10 9

Total Points 100 91