Taking the Work Out of Blood Work: A Parent's Guide

First – Then Board

What is it?

A First-Then Board is a visual display of something preferred that will happen after completing something that is not as preferred. During blood draws, a First-Then board can help motivate your child to take part in an activity that is not enjoyable by clarifying a preferred activity that will occur after it is over.

How do I teach it and use it?

First-Then Example

What if challenging behaviors occur?

If challenging behaviors occur, continue to focus on the task and praise the parts of the procedure your child is completing. Instead of shifting attention to the challenging behavior, provide brief statements or a visual that tell your child what you would like for them to do (e.g., hold your arm out). Then, provide access to the "Then" task when the procedure is complete. This is because the focus of the First-Then board is on completing the "First" task, not on addressing challenging behaviors that happen during it.

If you think challenging behaviors may occur, introduce your child to the First-Then board before the visit and practice them during daily activities he or she enjoys. This way, your child will already understand the meaning of this tool and will trust its use when it is brought out during blood draws and medical procedures.

If challenging behaviors become more difficult to manage, it may be appropriate to consider behavioral consultation with a professional to address these behaviors directly.