Table 4.

Guidelines for Applying Comprehensibility Adaptations to BIPs

	Step	Description	Example / Nonexample	Social Validity
1.	Concisely tell the reader what to do	Plan to use each document as a focused tool. Always give the most important information first and limit information to no more than three to four main messages per document (Catagnus et al., 2020; CDC, 2009). This should focus on what the reader needs to do or know, rather than what is nice to know. Remember that the point of the document is to change behavior, knowledge, or beliefs so writing must stay clear, appropriate, and to the point. This should tell the reader what actions they should take in a concise manner.	Example: “Quickly give a reward to Kiara after she finishes the task. Waiting to receive a reward can be frustrating for her.” Nonexample: “Try not to have long latencies (pauses between events and behaviors) when providing reinforcers to Kiara, even though these are sometimes unavoidable. Providing reinforcers immediately can help reduce challenging behavior.”	To convey quickly and clearly what should be done; to help the reader quickly remember and act on the information.
2.	Keep lists short and avoid rotating topics	Stick to one idea at a time and be sure it is fully covered (Catagnus et al., 2020). It is best to complete a whole idea rather than skipping between topics. This way, the reader does not need to piece together information from different sections. In addition, if you are listing items, this should be a short list with no more than three to seven bulleted items and should use an active voice (CDC, 2009). This is important because literacy deficits can affect one’s ability to recall information from long lists (CDC, 2009). If you have more information to list, it should be broken up with subheadings.	Example: 1. Tell Zander to do the writing task. 2. Point to the crayons and help him complete the task if needed. 3. Once his writing is done, smile and reward him with the coloring book. Nonexample: 1. Join Zander at the table and instruct him to write in his book. 2. Check on Zander’s math sheet after lunch. Don’t check every problem on the worksheet, just pick a few. But first have him finish writing. 3. When writing in the book, point to the crayon that you think Zander may want. This will work as a prompt to get him started. 4. Before moving on to lunch, make sure Zander finishes his writing. When he completes his writing, provide descriptive praise and access to the coloring book. Next have lunch and check his math work.	To build understanding of the topic without distraction by limiting the amount of information given at a time.
3.	Use simple language	Communicate in simple, conversational language as if you were talking to a friend (Jarmolowicz et al., 2008). You should also avoid passive statements and stick to the point. When giving directions, be sure to focus on what to do rather than what not to do (CDC, 2009). This will help you focus on the positive and keep your reader engaged. When information points out a person’s undesired behavior, they are less likely to act on it so information for parents and stakeholders should focus on staying proactive. Remember to be respectful, use an encouraging tone, and focus on small practical steps (Catagnus et al., 2020).	Example: 1.“You can show him which item to pick by pointing to the right picture.” 2. “Follow through with your first instruction by pointing to the right picture and waiting for him to copy.” Nonexample: 1. “Physical prompts can be added to facilitate correct responding.” 2. “Do not move on to different instructions if he does not respond to your first instruction; instead, add a prompt.”	To help the reader feel comfortable with instructions and support buy-in while clearly communicating.
4.	Use large clear fonts	Font sizes between 12 and 14 pts are easiest to read, whereas smaller fonts can be challenging for some readers (CDC, 2009). Section headings should be at least 2 pts higher than the body font and should avoid using all caps. Texts written in upper- and lowercase lettering are easier to read. Also, underlining, italics, and light text on dark backgrounds should be minimized as they reduce readability. Finally, be sure to stick with clear fonts that have distinct letters that are easy to read (Catagnus et al., 2020), rather than fancy, childish, or script fonts. See Figure 1 for examples.	Example: “Point to the faucet and wait for your child to copy you.” Nonexample: “Point to the faucet and wait for your child to copy you.”	To increase legibility and facilitate understanding.
5.	Use visuals that show actions	Visuals can improve communication when used correctly (Catagnus et al., 2020; CDC, 2009). As a rule, photographs of actions are most effective for showing events, emotions, and people. They can quickly gain the reader’s attention and tell a story (CDC, 2009). This works best when they are appropriately cropped, in focus, and do not feature distracting backgrounds (see example in Figure 2). Images should be screened by a representative audience to be sure they convey the intended behavior, such as actions like asking, prompting, reaching, and other postures that can be interpreted differently in a single snapshot. When photographs are not available, a clear illustration can be used to show a simple procedure like folding a towel. Illustrations should be simple drawings that avoid unnecessary detail (Choi, 2012; Houts et al., 2001). Finally, visuals intended to decorate should be avoided so that visuals are carefully selected and only displayed to clarify the text (CDC, 2009).	Example: Including a photograph for meal preparation featuring a grandparent helping a child eat with additional family members seated at the dinner table; to be used with an Indian American family in Houston, Texas living in a multigenerational home. Nonexample: Including a photograph for meal preparation featuring images from a popular commercial depicting several Indian American children dancing around a banquette table, to be used to be used with an Indian American family in Houston, Texas, living in a multi-generational home.	To model behaviors that are acceptable to the reader and clear enough to be imitated.
6.	Use short captions with images	When using visuals, you should present one message per visual and label visuals with short captions (CDC, 2009). The text should be near the visual, help explain the action, and use a tone and content that reflect the values and beliefs of the target culture (Singelis et al., 2018). Captions are most effective when written in complete sentences,using sticky language (catchy or memorable) and including the key message (Catagnus et al., 2020). Remember to use visuals and captions that show the reader what to do, rather than what not to do (CDC, 2009).	Example: 1.Accompanying and image with the caption, “Give a bigger reward for great behavior or a smaller reward for good behavior.” 2. Accompanying and image with the caption, “Give more attention for good behavior and less attention for bad behavior.” Nonexample: 1. Accompanying and image with the caption, “Don’t Reinforce!” 2. Accompanying and image with the caption, “It is important to reward target good behaviors that you want to see more of while ignoring the challenging behaviors that cause problems in your home. This way your child’s behavior will improve in ways that are important to your family.	To support fluency by the reader by making it quick and easy to understand and respond to the information.
7.	Use pictographs	Pictographs use picture sequences to quickly convey information and be memorable to audiences (Choi, 2012; Houts et al., 2001). They are best used to show specific actions, such as how medication is taken or how to complete a simple procedure (CDC, 2009; Choi, 2012; Houts et al., 2001). Pictographs can be incorporated into BIPS when teaching parents how to follow simple behavioral strategies (see example in Figure 3), to quickly help parents understand a sequence of actions (Choi, 2012; Houts et al., 2001), and can be combined with other recommendations for easy-to-read materials, including (1) well-focused, timed, and cropped action photographs (CDC, 2009); (2) limited messages per document (Catagnus et al., 2020); and (3) text and captions written in complete sentences and focused on telling the reader what to do (Catagnus et al., 2020; CDC, 2009).	Example: Including a pictograph for washing laundry featuring images (1) of a mother helping a child place items in a washing machine; (2) pouring detergent into a measuring cup; (3) pouring the cup of detergent into the washer; and (4) setting the knob to the “Regular Wash” setting. All images appear to feature the same models. Nonexample: Including a pictograph for washing laundry featuring images of (1) a child tugging on their shirt; (2) an elderly man reaching into a washing machine; and (3) a mother holding up a shirt while smiling at a teenager.	To show a behavior chain in short simple steps allowing the reader to perform relatively more complex behavior.

It may be beneficial to use the guidelines in this section to create a BIP template that can be used with a wide variety of images and strategies. This would allow practitioners to readily create a basic BIP strategy that can then be adapted to each family. See Figure 3 for an example.