Children’s Specialized, North Carolina – Case Study
Streamlining DTT delivery and improving client engagement across an early intervention team
Overview
At an early intervention clinic led by a seasoned clinical director, DTT was a core instructional method. The team faced persistent challenges with material preparation, inconsistent session delivery, and client disengagement. After implementing FirstWork, the clinic experienced greater instructional fidelity, improved efficiency, and significantly increased learner engagement—even among clients who had previously refused traditional DTT.
1. Replacing a Burdensome Prep Process
Problem:
DTT preparation was consuming hours of clinical time and resulting in disorganized, short-lived materials.
“I came from a world of language builder cards, printing my own pictures, laminating and cutting for hours, just to have the stimuli be lost before the week was over.”
Solution:
FirstWork digitized and streamlined the entire DTT process, eliminating the need for paper-based systems.
“I no longer must have sandwich bags full of printed pictures, taking 10 minutes to set up a session, and needing days to update stimuli as goals are mastered.”
Impact:
Lesson setup time dropped from 10+ minutes to near-instant access.
Materials were centralized, reusable, and impossible to misplace.
Staff shifted focus from logistics to instruction.
2. Increasing Fidelity and Confidence in Data
Problem:
Manual session management led to variability in how trials were run and how data was recorded.
“I don’t have to question if an RBT missed marking a trial as correct or incorrect.”
Solution:
With FirstWork, trial outcomes, error correction, and latency are captured automatically, ensuring accurate and consistent session data.
“I know that error correction is being run at 100% fidelity since it is automated. The latency will be captured accurately by the app instead of relying on counting or forgetting a stopwatch.”
Impact:
Data accuracy and reliability improved.
Clinical directors could monitor implementation with greater assurance.
BCBAs could focus on clinical decision-making, not procedural auditing.
3. Rapid Onboarding Across the Clinical Team
Problem:
New systems often come with training overhead and varied staff uptake.
Solution:
FirstWork was simple to implement. Within one week of introduction, the entire RBT team had adopted the tool.
“I first tried the app with my clients and then trained the BCBAs and RBTs in our center and we were off and running.”
“Within a week we had 14 RBTs using FirstWork for their clients’ programs.”
Impact:
Minimal training required for successful adoption.
RBTs quickly learned to copy BCBA-created decks and run sessions independently.
Ages served ranged from 23 months to 5 years—all clients were able to use the app effectively.
4. Transforming Client Engagement with DTT
Problem:
Some clients refused to engage with traditional flashcard-based DTT and became distressed or resistant during instruction.
Solution:
The digital format of FirstWork eliminated many barriers to engagement.
“We had clients who would refuse to engage with traditional DTT stimuli begin doing 5-6 DTT sessions during their therapy session.”
“They engaged with the material without refusal or tantrum behaviors and visibly enjoyed interacting with the app.”
Impact:
Previously resistant clients showed strong participation and motivation.
Staff observed skill emergence that had been masked by non-compliance during prior assessments.
Sessions became more enjoyable and productive for both learners and therapists.
5. Revealing Hidden Skills Through Alternative Delivery
Problem:
Client resistance during assessments led to underestimated skill levels.
Solution:
FirstWork enabled BCBAs to probe and assess through an engaging, low-resistance format.
“BCBAs have been able to probe skills with clients that were resistant to traditional assessment probes and gather data for clients’ baseline understanding for skills such as LRFFC and matching non-identical stimuli.”
“In using the FirstWork app with a 5-year-old client, he displayed fluency in skills that were not marked in his first VB-MAPP assessment due to his non-compliance with traditional teaching methods.”
Impact:
Accurate skill identification allowed for more tailored programming.
Clients demonstrated capabilities that traditional probes had failed to reveal.
Assessment became less adversarial and more data-rich.
Final Thoughts from the Clinical Director
“I have greatly enjoyed FirstWork and would recommend it to any ABA company that is looking to streamline their DTT process and engage clients in a fun new way of learning.”
