To separate relapse evidence from treatment integrity failure, version Esme's written treatment and audit every due opportunity, prompt, reinforcement event, schedule, timing rule, response definition, partner action, safety step, and access support. Retain missed and altered components. Repair implementation and determine whether recurrence occurred under the intended contingency before assigning a relapse process. Treatment drift is a result, not a client failure.

Lock the written treatment version

Record cue, response definitions, prompts, timing, reinforcement, safety, ordinary supports, stop rules, and effective date. Compare delivery with the version that actually governed each opportunity.

Keep every due event

Classify correct, early, late, omitted, altered, inaccessible, interrupted, extra, unsafe, invalid, and unobserved events. A fidelity denominator includes all events due under the sampling rule.

Stratify recurrence by integrity

Report the target and alternative responses under correct, flawed, and unknown implementation. Small strata require cautious interpretation and raw counts.

Repair both training and plan fit

A drift finding can call for clearer tools or coaching, while Esme's feedback may call for a clinical redesign. Accurate delivery of an unwanted plan is not success.

Use this sequence to separate relapse from integrity failure

Version Esme's plan, audit all due events, stratify recurrence, ask Esme, repair delivery and fit, collect bounded follow-up, and label only the evidence supported.

Build Esme's relapse and treatment-integrity audit

Create one versioned relapse and treatment-integrity audit for the shared-kitchen preparation routine. Include Esme's priority, response classes, phases, contexts, treatment versions, reinforcement, exposure, integrity, access, health, recurrence timing, safety action, direct experience, invalidity, missingness, withdrawal, candidate process, alternative explanations, design limits, decision, qualified owner, correction, and reassessment trigger. Store only decision-relevant information with role-limited access.

Validate Esme's recurrence evidence

Reproduce Esme's 15 correct + 3 late + 2 missing cue + 2 wrong consequence + 1 omitted + 1 unobserved = 24 due events. Seven recorded target responses produce a planned-event fraction of 7/24, or 29.2%. The unobserved event cannot enter an observed-response denominator, so the observed rate is 7/23, or 30.4%. Two target responses occur during 15 correct-integrity events, or 13.3%. The other five recorded target responses occur during eight observed flawed-integrity events, or 62.5%; retain the unobserved event as unknown. Verify due-event rules, plan version, partners, prompts, reinforcement, access, response classes, experience, retraining, and follow-up.

Connect Esme's evidence to a decision

Esme's decision table distinguishes immediate retraining, plan clarification, access repair, clinical revision, and process assessment. The team first confirms that the current plan still fits. Only then does it collect a bounded sample under repaired implementation, preserving the pre-repair record rather than overwriting it.

Work through Esme's example

Esme has 24 due routine opportunities after a staffing change. The written support is delivered correctly in 15, late in three, without the visual cue in two, with the wrong consequence in two, omitted once, and unobserved once. The prior target response is recorded seven times. That is 7/24 as a planned-event audit fraction and 7/23 across observed response opportunities. It occurs in 2/15 correct-integrity opportunities and 5/8 observed flawed-integrity opportunities. The unobserved event remains unknown in both response and integrity comparisons. The audit supports an implementation problem before a broad relapse conclusion. Preserve every planned and valid unit, response code, phase and context version, treatment component, reinforcement event, exposure, integrity result, access and health state, safety response, withdrawal, direct report, system failure, repair, correction, and unresolved item. This fictional example demonstrates one assessment control. It offers no diagnosis, person trait, universal relapse estimate, treatment effect, legal conclusion, coverage decision, payment promise, or outcome guarantee for Esme.

Address Esme's main interpretation risk

Presenting 7/24 as an observed-response rate treats the unobserved event as if no target occurred. Reporting recurrence without integrity strata also implies that the planned treatment was present. Fidelity still uses all 24 due events, while response occurrence uses 23 observed events and integrity comparisons separate 15 correct from eight observed flawed events. Training staff without checking whether the plan remains acceptable to Esme can also reproduce the wrong procedure more accurately. Review response and phase definitions, treatment history, reinforcement, exposure, context, integrity, access, health, partner behavior, direct experience, alternative explanations, authority, and design strength separately. A convincing graph cannot repair an unsafe, inaccessible, unwanted, or historically unsupported recurrence assessment.

Keep treatment scope and authority clear for Esme

For Esme's relapse and treatment-integrity audit, the CASP public summary supplies high-level ABA behavioral-health-treatment scope for autistic people, with licensed detail outside this page. The current BACB Ethics Code addresses competence, client involvement, consent and assent when applicable, medical needs, risk, data, documentation, evaluation, discontinuation, and transition for covered people. The BACB outline supplies examination content. These sources create no individualized relapse protocol or practice authority for Esme.

Distinguish early increase from recurrence for Esme

The historical Lerman and Iwata analysis reviewed extinction data and found early increases under a defined burst criterion in a minority of reviewed data sets. An extinction burst describes a time-linked early increase after extinction begins, whereas Esme's later recurrence question requires its own phase history. The study offers no universal prevalence estimate for current care, no safety authorization, and no prediction for the shared-kitchen preparation routine.

Use alternative-reinforcement and communication literature within scope for Esme

Athens and Vollmer evaluated differential reinforcement without extinction with seven children and varied dimensions such as immediacy, duration, and quality. The Tiger, Hanley, and Bruzek review discusses FCT assessment, response selection, partner response, schedule thinning, and related risks. These sources support careful history and delivery measurement for Esme; they supply no universal schedule, delay, consequence, or relapse outcome.

Use renewal evidence cautiously for Esme

The Podlesnik renewal review synthesizes basic and translational work on recurrence with context change while extinction or treatment contingencies remain. Much of that evidence comes from controlled laboratory arrangements. Understanding and Reacting to Relapse discusses practice-facing context and recurrence considerations. For Esme, define people, places, cues, treatment continuity, access, and integrity before applying renewal language.

Preserve broad relapse limits and communication access for Esme

Relapse and Its Mitigation distinguishes several recurrence histories and discusses mitigation concepts. It organizes hypotheses rather than proving which process occurred for Esme. ASHA's AAC portal says AAC users should always have access to communication tools or devices. Follow governing sources and preserve Esme's communication, health care, food, water, bathroom use, mobility, rest, relationships, safety, and emergency help throughout review.

Choose Esme's next bounded action

Esme asks for the visual cue to return and for the new partner to pause before prompting. Both changes are entered as a repaired version with a new effective date. Record the qualified owner, source evidence, effective date, current phase and treatment version, ordinary supports, access and health state, implementation check, accessible explanation, disagreement route, and reassessment trigger. Preserve the earlier record when responses, people, settings, systems, schedules, health, or priorities change. A repaired arrangement creates a dated phase rather than an error in Esme's prior performance.

Close Esme's relapse review

Review the relapse and treatment-integrity audit with Esme, the qualified behavior analyst, relevant partners, access owners, and specialists named in the manifest. Confirm that observed recurrence remains separate from resurgence, renewal, an extinction burst, treatment drift, access failure, health change, and treatment effect; every denominator is reproducible; AAC and basic access remain protected; urgent needs received action; and conclusions stay bounded to the supported history. Keep this page draft and noindex until every required review is complete.

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