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

First – Then Board

What is it?

A First-Then Board is a visual display that motivates patients to engage in medical procedures that are not preferred by clarifying the preferred items/activities that will be available after it is over.

How do I teach it and use it?

First Then Board

What if challenging behaviors occur?

Continue to focus on the task and praise the aspects of the procedure that child is completing. Rather than shifting attention to the challenging behavior, provide brief statements or a visual that tell the 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 occur during it.

If you anticipate challenging behaviors, encourage your patient’s parents to introduce their child to the First-Then board before the visit and practice them during preferred daily activities.

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