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Teaching Cooking Skills to a Man With Dual Diagnosis Using Backward Chaining (1993)

Teaching Cooking Skills to a Man With Dual Diagnosis Using Backward Chaining (1993)

 ©1993, 2013 by Dallas Denny

Source: Denny, Dallas. (1993, 30 July). Instructional Paper: Teaching cooking skills to a man with dual diagnosis using backward chaining. Paper for Dr. Katherine Heller, EXC 729, Georgia State University.





Instructional Paper

Teaching Cooking Skills to a Man With Dual Diagnosis

Using Backward Chaining


By Dallas Denny

For Dr. Katherine Heller

EXC 729

30 July, 1993




Alfred J. Packer is a 56-year-old man with a diagnostic of schizophrenia, paranoid type and severe mental retardation. His WAIS-R IQ is 52, but the WAIS-R is known to artificially inflate IQ scores of persons with intellectual impairments; his Stanford-Binet IQ of 32 is a better indicator of his intellectual functioning. His adaptive skills are very limited (Standard Score of 40 on the Vineland), with many weaknesses in domestic and community living skills because of his long years of living in an institution. He has a mild bilateral hearing impairment which makes it difficult for him to understand speech, and a seizure condition for which he takes Mysoline and Tegretol. He has mild spastic hemiplegia, which causes some weakness and tremor in his right arm. He is able to ambulate without difficulty.

Mr. Packer’s schizophrenia is controlled by Mellaril, which he takes every evening in pill form. Recently, when his medications were reduced, he became convinced the entire group home was going to relocate while he was at work, abandoning him. He became surly and noncompliant, but upon his monthly visit to the community mental health center the psychiatrist increased his medication to the previous level, and the symptoms quickly abated.

With his schizophrenic symptoms in remission, Mr. Packer is friendly and helpful around the group home. His verbal skills are sufficient to allow him to ask simple questions and to follow two-step commands.

The behavior specialist has noted that Mr. Packer is an eager and rapid learner, and feels many of the skills he lacks from 40 years of institutional living can be taught using simple behavioral techniques.


Mr. Packer lives in a group home with five other residents of both sexes. A live-in house manager is responsible for the operation of the home and supervises training of the residents by paraprofessional trainers.



To increase his domestic skills, the interdisciplinary team decided at Mr. Packer’s annual habilitation planning meeting that he would have a goal of learning to prepare a meal independently. The time frame for the goal was one year. The house manager was asked to develop the instructional plan.

First, the house manager stated the goal in objective terms:

In the group home, Mr. Packer will learn to independently prepare an entire meal for seven persons. “Independently prepare” is defined as setting the table with plates, glasses, napkins, silverware, and condiments, selecting food items from cupboard and refrigerator, gathering all needed utensils, opening packages, measuring and mixing ingredients, setting thermostats on stove and griddle, placing food in containers, cooking food (stirring or turning when necessary), removing food from stove when done, placing food in serving container, placing spoons in serving containers, placing serving containers on the table. and calling other house residents to come eat. Criterion for success will be independent preparation of a meal, with no verbal prompts and no gross errors as judged by the trainer.


Teaching Methodology

The meal during which Mr. Packer would be trained was breakfast, and the foods we would be trained to cook and serve were pancakes and bacon. Training would take place on Saturday and Sunday mornings, the only days when hot breakfast was served.

Mr. Packer was keenly interested in food, and was constantly underfoot during the breakfast meal. The house manager had already been assigning him tasks like setting the table and providing feedback for those tasks. She decided to use backwards chaining, as many of the “links” of the chain (for instance, setting the table) were already skills in Mr. Packer’s repertoire. He would be praised for correctly completing a task or sub-task, and if he was in error or seemed confused, he would be given verbal prompts. If necessary, the correct procedure would be modeled.


Use of Technology

Mr. Packer would be using many of the utensils and appliances found in any kitchen: Refrigerator, Stove, Electric Griddle, Dishwasher (he was encouraged to “clean as he went”), knives, etc.



The only adaptations necessary were to provide a one-cup measure and a ladle and to indicate proper settings for electric griddle and stove. The house manager used Liquid Paper, placing a short line on the stove and griddle bodies, and corresponding short lines on the thermostat dials. Mr. Packer had only to line up the white marks. As training continued, routine use of the kitchen caused the white lines to fade. They were not renewed, as the fading was in actuality fortuitous, saving the house manager the trouble of fading the marks herself.



As the house manager prepared the meal, she asked Mr. Packer to take increasing charge of the meal preparation. As he mastered each step in the sequence, he was made responsible for a higher number. At each step, he would enter the food preparation process earlier in the chain and would carry it on to the end, which was called “breakfast.”

  1. A. Mr. Packer will set the table (skill already in repertoire); this step was used primarily to set the stage for meal preparation.
  2. Mr. Packer will place utensils in full food containers on table.
  3. Mr. Packer will carry full food containers from kitchen to table.
  4. Mr. Packer will remove cooked food from griddle and stove, and place it in containers.
  5. Mr. Packer will turn food at the midway point in the cooking process.
  6. Mr. Packer will ladle pancakes onto griddle and place bacon in skillet.
  7. Mr. Packer will turn on griddle and skillet to 350 degrees.
  8. Mr. Packer will open package of bacon and stir pre-mixed pancake ingredients.
  9. Mr. Packer will measure two cups of pancake flour, two cups of milk, two eggs, and one-half cup of cooking oil into a large mixing bowl.
  10. Mr. Packer will assemble all needed cooking ingredients.

In actual practice, it was sometimes possible to combine two steps due to Mr. Packer’s eagerness to learn. For instance, steps 1, 2, and 3 were combined.



Mr. Packer learned quickly, responding well to verbal prompts and modeling. Only one instance of modeling was required at each step; he was then able to do the task with only light verbal prompting.

Criterion was reached unexpectedly soon when the house manager overslept one Sunday morning. She was wakened by Mr. Packer calling, “Breakfast is ready.” Indeed it was, complete with golden pancakes with syrup, milk and orange juice, and bacon, and a smiling Alfred J. Packer.



Mr. Packer’s history of hanging around the kitchen watching the house manager prepare breakfast had resulted in a considerable amount of observational learning. The instructional plan was probably more molecular than was actually needed, and learning would have been optimized by taking a more molar approach to a variety of tasks; that is, the same amount of data collecting and training time could have been spread out across a number of areas (for instance, laundry, vacuuming, and raking the yard.

Blank Data Sheet

Blank Data Sheet/Alfred J. Packer


Instructions: Start with Step 1. When Mr. Packer successfully completes a step, move to the next higher step. Circle highest step independently completed.

Criterion: Independent preparation of one meal (no verbal prompts, no gross errors). Use your judgement about what a “gross error” is.

 Date Started:



9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9

8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8

7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1



  1. Place utensils in full food containers on table.
  2. Carry full food containers from kitchen to table.
  3. Remove cooked food from griddle/stove, & place in containers.
  4. Turn food at the midway point in the cooking process.
  5. Ladle pancakes onto griddle and place bacon in skillet.
  6. Turn on griddle and skillet to 350 degrees.
  7. Open package of bacon and stir pre-mixed pancake ingredients.
  8. Measure ingredients.
  9. Assemble all needed cooking ingredients.