Caregiver Journal For ECST Part 2 Modules 9 To 15 Fillable v2

WHO eLearning Caregiver Skills Training Programme for
Families of Children with Developmental Delays or Disabilities
Caregiver Journal Part 2

For use with Modules 9 to 15
© World Health Organization 2022

Some rights reserved. This work is available under the Creative Commons Attribution-
NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO;
https://creativecommons.org/licenses/by-nc-sa/3.0/igo).
Table of Contents
How to use this journal ............................................................................................. 4

Module 9: Teaching New Skills in Small Steps and Levels of Help ............................ 6
Home practice review ............................................................................................... 6
Your goals for teaching new skills ............................................................................ 7
Home practice plan – Module 9 ............................................................................... 9
Module 9: Tips for your home practice..................................................................... 9
Module 10: Understanding your child’s behaviours .............................................. 10
Home practice review ............................................................................................. 10
Your goals for improving your child’s behaviour .................................................... 11
Writing practice: Your child’s behaviour ................................................................ 12
Home practice plan – Module 10 ........................................................................... 13
Module 10: Tips for your home practice ................................................................ 14
Module 11: Preventing Challenging Behavior - Helping Children Stay Engaged and
Regulated ............................................................................................................. 15
Review the behaviour thermometer ....................................................................... 16
Module 12: Understanding the Reasons for Challenging Behaviour ...................... 19
Module 13: Teaching Alternatives to Challenging Behaviour ................................. 22
Your goals for responding to your child’s behaviour .............................................. 23
Module 14: Ongoing Practice and Goal Setting ..................................................... 27
2
Your child’s progress ............................................................................................... 28
Expanding your Routines ........................................................................................ 31
Module 15: Problem-Solving and Self-Care ........................................................... 34
Writing practice: your self-care .............................................................................. 35
3
How to use this journal
This journal is meant to be used with the WHO eLearning Caregiver Skills
Training for Families of Children with Developmental Delays or Disabilities
(available at https://openwho.org/courses/caregiver-skills-training).
We suggest the use of this journal (printed or saved to your device) to write
down or highlight the concepts, tips and strategies you want to remember
and have at hand when practising the strategies.
To complete your journal electronically, you may need to download free PDF
software. One option is available here: https://get.adobe.com/reader/
Alternatively, it is fine to use your own paper journal and write down the
questions, strategies and suggestions.
Already included in your journal are

• A summary of strategies from each module
• Written exercises for each module
• Suggestions for home practice
You may also use your journal to write down some of the knowledge about
your child that you will develop during the training and the answers to the
quiz questions at the end of each module.
4
Programme Overview: Modules 9 to 15
Module Topic Page
Teaching new Teaching New Skills in Small Steps and
skills Module 9 6
Levels of Help
Module 10 Understanding Your Child’s Behaviour

10
Behaviour
Preventing Challenging Behaviour,
Module 11 - Helping Children Stay Engaged and 15
Regulated
Understanding the Reasons for

Module 12 19
Challenging Behaviour
Teaching Alternatives to Challenging

Module 13 22
Behaviour
Ongoing practice
Module 14 Ongoing Practice and Goal Setting 27
and goal setting
Self-care Module 15 Problem-Solving and Self-Care 34
5
Module 9: Teaching New Skills in Small Steps and
Levels of Help
Home practice review

Let’s review your home practice from module 8 on using “show and say” to
demonstrate gestures and words and promoting communication to share and
request.
Answer the questions below:
Which words and gestures did you demonstrate during show and say?
_____________________________________________________________
_____________________________________________________________
How did your child react to your words or gestures?
_____________________________________________________________
_____________________________________________________________
6
What types of communication did the child use?
_____________________________________________________________
_____________________________________________________________
How did you expand that communication?
_____________________________________________________________
_____________________________________________________________
What could you have done differently?
_____________________________________________________________
_____________________________________________________________
Remember to repeat your child’s words and expand your child's language
by adding one word. It’s also important to create opportunities for your
child to communicate to share (show or tell someone about something), or
request (ask someone for something).
Your goals for teaching new skills

We will focus on a skill for daily living that you want your child to do, and we will
break it down into small steps. We will pick one step you can use to begin to
teach your child. Answer the questions below:
What is one daily activity you want your child to do successfully?
_____________________________________________________________
7
What are all of the small steps in this activity?
____________________________ _____________________________
____________________________ _____________________________
____________________________ _____________________________
____________________________ _____________________________
____________________________ _____________________________
____________________________ _____________________________
Can your child do one or more steps on their own?
_____________________________________________________________
Tips for planning:
• Choose a small step to start with. This will be your target step.
• As you try the activity, you gather more information about what your child
can do and what your child needs help to do.
• This information can change your goals. That is OK!
• Each time you practise the target skill with your child, think about your
goals. The goals may change. Your child may have learned the skill, or you
may need to back up.
8
Home practice plan – Module 9
It’s time to prepare for your next home practice activity. Follow the tips below:
• Choose a task of daily living that you want your child to learn. (the bigger
task, for example washing hands, taking off shoes or putting on a shirt).
• Think of all the small steps in this routine and choose one small step to
teach your child.
• Plan the level of help you will start with:

○ The three levels are Show and say, a little physical help, and a lot of
physical help.
○ Give the lowest level of help needed for your child to be successful.
○ Give clear and consistent instructions and praise your child for trying.
Also consider:
○ How will you know if your child needs more help?
○ What will you do next if your child needs more help?
○ How will you know if your child needs less help?
Module 9: Tips for your home practice

• Break the skill down into small steps and teach your child one small step at
a time.
• Let your child learn! Give the lowest level of help needed for your child to
be successful.
• Give clear and consistent instructions and praise your child for trying.
• Ask yourself: Can I teach a different step?
Remember to practise self-care as well. You can continue with the self-care
activities you are already doing or try something new before you start the next
module.
9
Module 10: Understanding your child’s behaviours

In the last session you chose a target skill (small step) to teach your child within a
routine using the Three Levels of Help. Take a moment to think about the target
you set for your child during the last session and answer the questions below:
What skill for daily living did you practise with your child?
_____________________________________________________________
What was the target small step?
_____________________________________________________________
What level of help did you provide for the target step?
_____________________________________________________________
10
Remember, the three levels of help are:
LEVEL 1: Show and say: Show your child what to do and say the step in
words your child can understand. If your child doesn’t try it, say the step
one more time to remind her/him.
LEVEL 2: Give a little physical help to start or finish the action.
LEVEL 3: Give a lot of physical help by gently taking the child’s hand and
doing the whole action from start to finish.
Your goals for improving your child’s behaviour
Can you think of one or two behaviours that you would like to see occurring less
frequently? Record them below.
The challenging behaviour I want to see less often is:
Challenging behaviour 1…
_____________________________________________________________
Challenging behaviour 2…
_____________________________________________________________
It is important to look and listen for signals before the challenging

behaviour. Remember to arrange your environment and give warnings
before you change activities to help your child stay cool.
11
Writing practice: Your child’s behaviour
Think about your child’s behavior and answer the questions below using the
Behaviour Thermometer.
RED
YELLOW
GREEN
What do you notice when your child shows red or hot behaviour?
_____________________________________________________________
What do you notice when your child shows yellow or warm behaviour?
_____________________________________________________________
What do you notice when your child shows green or cool behaviour?
_____________________________________________________________
12
Remember:
● When your child shows red or hot behaviour, she/he may be crying,
screaming, running away, or rolling on the floor.
● When your child shows yellow or warm behaviour, she/he may

fidget, look around, or not participate in the routine.
● When your child shows green or cool behaviour, she/he may be

smiling and laughing, or have a relaxed body.

It’s time to prepare for your next home practice activity.
Create a “WANT TO SEE MORE” list:

Examples of behaviours that you would like to see more of are things your
child DOES, like a task you ask them to do, using words or gestures to
communicate, etc.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Observe your child’s behaviour and create a list of warning signs for
challenging behaviours:
Examples of when your child shows yellow or warm behaviour are when
they may whine, fidget, look around, or not participate in the routine.
13
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
• Children learn best when they are calm and cool.
• Your child can show “red/hot”, “yellow/ warm” or “green/cool” behaviours.
• Look and listen for signals before the challenging behaviour to help you
identify warning signs for challenging behaviours.
module.
Notes:
14
Module 11: Preventing Challenging Behavior -
Helping Children Stay Engaged and Regulated

In the last session you were asked to create two lists: behaviours you want to see
more of, and warning signs for challenging behaviour.
What behaviours did you notice that you would like to see your child show
more of?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
What did you observe about your child right before a challenging
behaviour?
_____________________________________________________________
_____________________________________________________________
15
Were the warning signs different from what you expected?
_____________________________________________________________
_____________________________________________________________
Review the behaviour thermometer

Using the Behaviour Thermometer from the previous module, write down what
you noticed about your child’s behaviour during your home practice. Did you see
the three levels of behaviour?
HOT/RED (Not regulated but agitated)

Very upset, angry or overexcited, and needs help to calm down.
_____________________________________________________________
_____________________________________________________________
WARM/YELLOW
Showing the first signs of agitation, frustration, distress or upset.
_____________________________________________________________
_____________________________________________________________
COOL/GREEN (Regulated)
Calm, alert and ready to learn
_____________________________________________________________
_____________________________________________________________
16
It’s time to prepare for your next home practice activity.
Choose two activities to do with your child.

_____________________________________________________________
_____________________________________________________________
Think of possible challenging behaviours that your child may show during
these activities (What does the behaviour sound or look like?)
_____________________________________________________________
_____________________________________________________________
For each activity, use the strategies you learned to help your child stay calm and
cool:
● Choose a good time to do the activity.
● Make the activity more fun or enjoyable.
● Show and tell your child what to expect.
● Give your child a short break if needed.
If you observe yellow or red behaviour, think about what happened right before
the challenging behaviour.
17
• Respond to skills and appropriate behaviour with praise and

encouragement.
• Look and listen for signals before the challenging behaviour.
• Arrange your environment and give warnings before you change activities
to help your child stay cool.
• If your child has a “meltdown” or “tantrum”, stay calm and wait for the
child to calm down. Then think about the reason for the behaviour.
module.
Notes:
18
Module 12: Understanding the Reasons for
Challenging Behaviour
You were asked to use strategies to help your child stay clam and cool and notice
your child’s challenging behaviour and what happened before the behaviour.
Reflect on your home practice and respond to the questions below:
What cool, warm, and hot behaviours did you see during your 5-minute
practices?
_____________________________________________________________
Which strategies did you use to help your child stay calm and cool?
_____________________________________________________________
Which strategies did you use to manage a challenging transition (changing

from one activity to another)?
_____________________________________________________________
19
If your child showed challenging hot or warm behaviour, what happened
before the behaviour?
_____________________________________________________________
What can you do when your child shows yellow and red behaviour?
_____________________________________________________________
Remember:
● Children can communicate using challenging behaviour to get access,

attention, to avoid something, or to get a sensation.
● Remember to look and listen for signals before the challenging behaviour
occurs.
Home practice Activity

It’s time to prepare for your next home practice activity. Use your journal to
review your target challenging behaviours and think of two activities where these
behaviours occur.
For each activity, answer the following questions:
1. What happened before the challenging behaviour?
______________________________________________________________
20
2. What challenging behaviour did the child show (describe the
behaviour)?
______________________________________________________________
3. What happened after the behaviour?
______________________________________________________________
4. Decide: What is the reason for the behaviour?

o To get Access
o To seek attention
o To avoid or stop something
o To get a sensation

• You can use picture schedules to help your child understand activities and
stay calm.
• Think about what happened before, during and after the challenging
behaviour to find out the reason for the behaviour.
Notes:
21
Module 13: Teaching Alternatives to Challenging
Behaviour

You were asked to notice your child’s target challenging behaviours and decide on
the reason for each behaviour.
Reflect on your home practice and respond to the questions below
For target challenging behaviour #1
What challenging behaviour did the child show (describe the behaviour)?
________________________________________________________________
What happened before the behaviour?
________________________________________________________________
What happened after the behaviour?
________________________________________________________________
What is the reason for the behaviour?

_______________________________________________________________
22
For target challenging behaviour #2
What challenging behaviour did the child show (describe the behaviour)?
________________________________________________________________
What happened before the behaviour?
________________________________________________________________
What happened after the behaviour?
________________________________________________________________
What is the reason for the behaviour?

_______________________________________________________________
Remember:
• The reasons for challenging behaviour are to get access or attention, to

avoid something, or to get a sensation.
• Remember to look and listen for signals before the challenging behaviour
occurs.
Your goals for responding to your child’s behaviour

Think about your goals for your child’s behaviour, then complete the sentences
below. Next, you will decide how to respond to your child's behaviour.
The two activities I plan to do with my child are...
1. _____________________________________________________________
23
2. _____________________________________________________________
The challenging behaviour I would like to reduce in our activities is...
________________________________________________________________
The reason for this behaviour is…
________________________________________________________________
Use this chart to help you set goals for how to respond to your child's behaviour
If the message sent Our goal when we respond is to:

with the behaviour is:
To Get Access to Help the child use communication skills to ask (using a
Something gesture, sign, picture or saying a word) OR if you do not
want to provide the item, be consistent and do not give
the item when there is challenging behaviour.
To Get Attention Give no attention or response for challenging behaviour

(ignore the behaviour) and reward appropriate behaviour
and skills with praise and attention.
To Stop or Avoid Set clear, consistent and appropriate expectations and

Something help your child understand that challenging behaviour
will not stop the activity.
To Get Sensation Provide a safe and appropriate way of getting the

sensation and help your child communicate to get the
sensation they want.
24
How will you respond to your child’s behaviour?
________________________________________________________________

It’s time to prepare for your next home practice activity. Review your target
challenging behaviours and plan how to respond to each challenging behaviour.
• Think of two activities where challenging behaviour often occurs.

• Describe the behaviours that your child might show.
• Think of the reason for each behaviour and your plan to respond.
For example:
Activity 1
Behaviour...
________________________________________________________________
Reason for behaviour...

________________________________________________________________
Plan to respond...
________________________________________________________________
25
Activity 2
Behaviour...
________________________________________________________________
Reason for behaviour...

________________________________________________________________
Plan to respond...
________________________________________________________________

• Find out the reason for your child’s challenging behaviour and decide how
to respond based on that reason (to get access or attention, to avoid, or to
get a sensation).
• Respond to challenging behaviour that aims to get access by teaching a
child to use words and gestures.
• Ignore challenging behaviour that is seeking attention if it is safe and OK to
do so.
• Set clear, consistent and appropriate expectations to reduce challenging
behaviour to avoid or stop a routine.
• Teach a safe and appropriate behaviour to replace sensation-seeking
challenging behaviour.
module.
26
Module 14: Ongoing Practice and Goal Setting

Let’s review your home practice from Module 13. You were asked to:
• Choose 2 everyday activities to do with your child.

• Spend 5 minutes with your child every time you do the activities together.
• Look and listen for what happens before, during and after the challenging
behaviour.
• Use the plan made to respond to the challenging behaviour.
Answer the questions below about your practice:
Which home activities did you try?

________________________________________________________________
________________________________________________________________
Which challenging behaviours occurred?

________________________________________________________________
________________________________________________________________
27
What was the reason (or reasons) for the behaviour?
________________________________________________________________
________________________________________________________________
How did you respond?

________________________________________________________________
________________________________________________________________
What things can you try next time?

________________________________________________________________
________________________________________________________________
Your child’s progress

Think about the activities you have chosen to work on and the goals you set for
improving your child’s communication, behaviour, and the small step of a larger
skill.
Answer the following questions:
What progress have you made towards these goals?

________________________________________________________________
________________________________________________________________
28
Have you noticed any other positive changes in your child?
________________________________________________________________
________________________________________________________________
What did you do to achieve this progress?

________________________________________________________________
________________________________________________________________
What difficulties did you have as you worked toward your goals?
________________________________________________________________
________________________________________________________________
How will you continue to practise with your child?

________________________________________________________________
________________________________________________________________
29
Planning your child’s next communication goals
This chart can help you decide on your child’s next communication goals
Requesting Sharing
Child is not yet requesting Child is not yet sharing
Child uses eye contact to request Child uses eye contact to share
Child uses gestures: reach to Child uses gestures: show to share,

request, give to request, point to point to share, give to share
request
Child uses a single word to request Child uses a single word to share
Child uses 2 words together to Child uses 2 words together to

request share
Child uses 3 or more words Child uses 3 or more words
together to request together to share
Child combines many words, Child combines many words,
gestures and eye contact to gestures and eye contact to share
request
How to use this chart:
Write down the step that follows where your child is now – these will be your
child’s next communication goals.
30
1. Find the description of how your child is communicating to request and to
share now.
______________________________________________________________
______________________________________________________________
2. Write down the step that follows where your child is now – these will be
your child’s next communication goals.
______________________________________________________________
______________________________________________________________
Example: If your child is not yet requesting, her/his next communication

goal is to use eye contact to request.
Expanding your Routines
Which two routines that you already do with your child could you expand on?
Write your answer below.
1. ______________________________________________________________
2. ______________________________________________________________
Remember:
• Sometimes your child won’t follow new steps or link one routine to
another. That’s ok! It’s important to keep trying!
• You may have to try different strategies learned throughout this course to
expand the routine.
31
• You may also find success in using the same strategy many times before
your child eventually tries it.

It’s time to prepare for your next home practice activity. Think about how you will
use show and say to teach your child new steps
Building children’s skills:
• For each of the home routines you are working on, decide on the next 2 or
3 small steps. Plan to start teaching your child at least one of those steps
within the next few days.
Routine 1
The next 2 or 3 steps I can teach my child are...
1. ______________________________________________________________
2. ______________________________________________________________
3. ______________________________________________________________
Routine 2
The next 2 or 3 steps I can teach my child are...
1. ______________________________________________________________
2. ______________________________________________________________
3. ______________________________________________________________
32
• Continue to set goals for yourself and your child and review your progress.
• Expand your routine: use show and say to add new steps.
• Link two routines together to expand a routine that the child can do.
module.
Notes:
33
Module 15: Problem-Solving and Self-Care

You were asked to:
• Think of routines you already do with your child that you could expand on.
• For each of the home routines you are working on, decide on the next 2 or
3 small steps.
• Plan to start teaching your child at least one of those steps.
Answer the following questions about your practice
Which play and home routines did you try?
_____________________________________________________________
_____________________________________________________________
For the play routine:
What were the steps or new materials you tried to add?
_____________________________________________________________
Was your child able to do the new steps or use the new materials?
_____________________________________________________________
34
Did you offer any help? (Remember that the levels of help are Show and
say, provide a little physical help and provide a lot of physical help)
_____________________________________________________________
_____________________________________________________________
For the home routine:
Did you do the steps in a different order?
_____________________________________________________________
Were there 2 routines you tried to link together?
_____________________________________________________________
_____________________________________________________________
What things can you try next time?
_____________________________________________________________
_____________________________________________________________
Writing practice: your self-care
Think about the following questions and write your answers below:
What are you already doing to take care of yourself and soothe the stress
that can come with caring for a child with a developmental difficulty?
35
______________________________________________________________
______________________________________________________________
What self-care activities would you like to do more of?
______________________________________________________________
______________________________________________________________
Are there any new self-care activities that you could try?
______________________________________________________________
______________________________________________________________
How would you like these activities to help you? (e.g., to be more patient,
have more energy, feel less tired or feel more connected to others)
______________________________________________________________
______________________________________________________________
Remember:
• When you are less stressed it is easier to remain calm and consistent, and
best engage with your child. This is best for your child’s learning.
36
Self-Care:
Choose 1 activity that is important to you and plan to spend at least 5
minutes doing this activity every day or every other day.
________________________________________________________________
This could be a very simple activity such as talking to someone you care
about, singing, doing something for others or spending 5 minutes sitting
quietly, etc.

• Expand your routine: use show and say to add new steps.
• Link two routines together to expand a routine that the child can do.
• Care for yourself to help you and your child.
• You can find solutions to problems by problem-solving.
Notes:
37

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Caregiver Journal For ECST Part 2 Modules 9 To 15 Fillable v2

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WHO eLearning Caregiver Skills Training Programme for

Families of Children with Developmental Delays or Disabilities

Caregiver Journal Part 2

© World Health Organization 2022

How to use this journal ............................................................................................. 4

Already included in your journal are

Module 10 Understanding Your Child’s Behaviour

Understanding the Reasons for

Teaching Alternatives to Challenging

Self-care Module 15 Problem-Solving and Self-Care 34

Home practice review

Answer the questions below:

How did your child react to your words or gestures?

How did you expand that communication?

What could you have done differently?

Your goals for teaching new skills

What is one daily activity you want your child to do successfully?

Can your child do one or more steps on their own?

Tips for planning:

• Plan the level of help you will start with:

Module 9: Tips for your home practice

Home practice review

What was the target small step?

LEVEL 2: Give a little physical help to start or finish the action.

Your goals for improving your child’s behaviour

The challenging behaviour I want to see less often is:

It is important to look and listen for signals before the challenging

● When your child shows yellow or warm behaviour, she/he may

● When your child shows green or cool behaviour, she/he may be

Home practice plan – Module 10

Create a “WANT TO SEE MORE” list:

Module 10: Tips for your home practice

• Children learn best when they are calm and cool.

• Your child can show “red/hot”, “yellow/ warm” or “green/cool” behaviours.

Home practice review

Review the behaviour thermometer

HOT/RED (Not regulated but agitated)

Choose two activities to do with your child.

• Respond to skills and appropriate behaviour with praise and

• Look and listen for signals before the challenging behaviour.

Home practice review

Reflect on your home practice and respond to the questions below:

Which strategies did you use to manage a challenging transition (changing

● Children can communicate using challenging behaviour to get access,

Home practice plan – Module 12

Home practice Activity

For each activity, answer the following questions:

1. What happened before the challenging behaviour?

3. What happened after the behaviour?

4. Decide: What is the reason for the behaviour?

Module 12: Tips for your home practice

Home practice review

Reflect on your home practice and respond to the questions below

For target challenging behaviour #1

What happened before the behaviour?

What happened after the behaviour?

What is the reason for the behaviour?

What happened before the behaviour?

What happened after the behaviour?

What is the reason for the behaviour?

• The reasons for challenging behaviour are to get access or attention, to

Your goals for responding to your child’s behaviour

The two activities I plan to do with my child are...