Social Validity Assessment of Training Methods to Improve Treatment Integrity of Special Education Service Providers

We report the results of a social validity assessment that was administered to special education service providers (N = 44) to document the acceptability and effectiveness ratings of several treatment integrity training methods. The participants judged performance feedback as the most likely method to improve their treatment integrity, followed by avoidance (negative reinforcement) of supervision meetings, online training, and financial incentive. Performance feedback was also rank-ordered as most effective among the four training methods. We discuss the merits of social validity assessment in designing programs for enhancing treatment integrity among practitioners within educational and clinical settings.

Simplified Habit Reversal and Treatment Fading for Chronic Skin Picking in an Adolescent With Autism

We evaluated the effects of simplified habit reversal (HR) that combined competing response training and differential reinforcement on skin picking by an adolescent female with autism attending a classroom at a specialized school. The competing response training procedure allowed her to manipulate preferred sensory stimuli independently and when instructed by classroom staff. Differential reinforcement included praise and tokens that she received following intervals without skin picking and when she performed competing response training. Compared with a baseline phase, skin picking decreased with simplified HR and during a subsequent phase when treatment was faded by implementing differential reinforcement without competing response training. We discuss the clinical implications of these findings.

Effects of Fixed-Time Release Fading on Frequency and Duration of Aggression-Contingent Physical Restraint (Protective Holding) in a Child With Autism

We report the case of an 11-year-old boy with autism who displayed aggressive behavior and required aggression-contingent physical restraint (protective holding) to protect peers and teachers from injury. During a baseline phase, teachers implemented the boy’s behavior support plan and applied protective holding according to a behavior-contingent release (BCR) criterion in which they maintained physical contact with him until he was “calm” for a minimum of 30 consecutive seconds. In the intervention phase, baseline procedures remained in effect, but the teachers terminated protective holding with the boy according to a fixed-time release (FTR) criterion that was independent of his behavior during protective holding and faded (decreased) systematically over time. In contrast to BCR, FTR fading was associated with less exposure to and fewer applications of protective holding. Post-intervention and follow-up results revealed that protective holding was no longer required. We discuss the clinical implications of these findings.

Direct and collateral effects of staff-worn protective equipment on injury prevention from child aggression

OBJECTIVE

The present study measured arm and other body injuries to classroom staff that were caused by a student who had developmental disabilities and treatment-resistant aggression.

METHODS

Following a baseline (no equipment) phase, staff wore protective equipment on their arms but not on other areas of their body.

RESULTS

The frequency of self-reported arm injuries increased with protective equipment, but injury severity decreased. Wearing the protective equipment was also associated with more injuries to other areas of the body.

CONCLUSIONS

Staff-worn protective equipment may reduce the severity but not the frequency of staff injuries from aggression; as well, the presence of protective equipment may set the occasion for increased injuries to non-protected areas of the body.

Descriptive Analysis of a Staff Injury-Reduction Intervention in a Human Services Setting for Children and Youth With Intellectual and Developmental Disabilities

Clinical safety is a dominant concern for human services organizations serving people with intellectual and developmental disabilities (IDD) and high-risk challenging behaviors. This article is a descriptive analysis of components that comprised an injury-reduction intervention among direct-care staff at a specialized school. Using a behavior-based safety approach, intervention was associated with fewer staff injuries and more weeks without injury reports. The article focuses on systems-level strategies and recommendations for future research and practice.

Preventing injury from child aggression: a single-case evaluation of the effects of staff-worn protective equipment

OBJECTIVE

This single-case study of a boy with autism and high-frequency aggression concerned the effects of classroom teachers wearing protective equipment (gloves) on injuries produced to their hands as well as injuries sustained to non-protected areas of the body.

METHODS

A reversal-type design was used to evaluate the effects of protective equipment relative to a baseline (no protective equipment) phase, a low-demand activity phase without protective equipment and a low-demand activity phase with protective equipment.

RESULTS

The protective equipment intervention eliminated hand injuries, did not result in other types of injuries, was not associated with increased aggression and was rated favourably by the classroom teachers.

CONCLUSION

The findings suggest that staff-worn protective equipment may be a valuable component of comprehensive clinical safety programmes within service settings for children with intellectual and developmental disabilities.

Graduated exposure and positive reinforcement to overcome setting and activity avoidance in an adolescent with autism

Some students who have developmental disabilities avoid settings and activities that can improve their learning and quality of life. This two-phase study concerned an adolescent boy with autism who avoided the gross-motor exercise room, gymnasium, and music room at his school; he demonstrated distress, agitation, and problem behaviors when prompted to enter these areas. Using graduated exposure combined with positive reinforcement, he learned to enter these settings without resisting and eventually to participate in activities within the settings. This article discusses this intervention approach for reducing and eliminating avoidant behavior.

Graduated Exposure, Positive Reinforcement, and Stimulus Distraction in a Compliance-With-Blood-Draw Intervention for an Adult With Autism

The authors report the case of a 21-year-old man who had autism and feared having his blood drawn as a required medical procedure. He was first exposed to simulated blood draws during a baseline phase and subsequently an intervention phase that (a) gradually exposed him to the procedures that constituted a blood draw, (b) reinforced his compliant behavior, and (c) provided stimulus distraction. He successfully completed intervention and tolerated actual blood draws 1 month and 4 months later. The authors discuss clinical and research issues when conducting intervention for medical fears among people who have intellectual and developmental disabilities.

Review of sports performance research with youth, collegiate, and elite athletes

This brief review summarizes translational and intervention research in the area of sports performance. We describe studies with youth, collegiate, and elite athletes; identify recent trends; and propose recommendations for future research.

Behavioral coaching to improve offensive line pass-blocking skills of high school football athletes

We evaluated several behavioral coaching procedures for improving offensive line pass-blocking skills with 5 high school varsity football players. Pass blocking was measured during practice drills and games, and our intervention included descriptive feedback with and without video feedback and teaching with acoustical guidance (TAG). Intervention components and pass blocking were evaluated in a multiple baseline design, which showed that video feedback and TAG were the most effective procedures. For all players, improved pass blocking matched a standard derived by observing more experienced linemen and was evident in games. Additional intervention was required to maintain pass-blocking proficiency. Issues pertinent to behavioral coaching and sport psychology research are discussed.

A behavioral intervention for teaching tackling skills to high school football athletes

We evaluated an intervention that combined task analysis and differential reinforcement for teaching tackling skills to 2 high school football athletes. As a result of intervention, both players tackled more proficiently in practice drills and maintained proficient tackling during games.

Descriptive analysis of physical restraint (protective holding) among community living adults with intellectual disability

We analyzed incidence and implementation patterns of physical restraint (PR) among 448 adults with intellectual disability within community-based day habilitation programs and group homes. PR was implemented exclusively as a consequence for self-harming, aggressive, and environmentally disruptive behaviors. Less than 10% of adults received PR and more than 90% of documented restraints occurred as a planned intervention procedure. Several adults accounted for the majority of PR. The clinical implications of these findings are discussed.

Teaching applied behavior analysis knowledge competencies to direct-care service providers: outcome assessment and social validation of a training program

Staff training is a critical performance improvement objective within behavioral health care organizations. This study evaluated a systematic training program for teaching applied behavior analysis knowledge competencies to newly hired direct-care employees at a day and residential habilitation services agency for adults with intellectual and developmental disabilities. Three content areas--measurement, behavior support, and skill acquisition--were trained in a group format using Powerpoint® presentations that featured didactic instruction, practice exercises, and video demonstrations. The employees completed an assessment of knowledge test before and after training in each content area. Across five training groups, the average correct posttraining test scores were consistently higher than pretraining test scores. A social validity assessment revealed that the employees judged the training program favorably along several dimensions. Issues pertaining to staff training and performance improvement initiatives are discussed.

Writing for Publication: A Performance Enhancement Guide for the Human Services Professional

More human services professionals need to write for publication in peer-reviewed journals. This article discusses some of the perceived obstacles to writing for publication and how to overcome them by implementing a performance enhancement plan. By following a few basic guidelines, practitioners can write productively, publish their work successfully, and contribute meaningful findings, opinions, and recommendations to the professional community.

Performance Improvement in Behavioral Health Care: Collateral Effects of Planned Treatment Integrity Observations as an Applied Example of Schedule-Induced Responding

With rising interest in the role of treatment integrity on student outcomes, research has primarily focused on isolating the techniques and procedures necessary to improve staff’s acquisition and maintenance of adequate levels of integrity. Despite increasing numbers of publications on this topic, there has been little discussion of the variables surrounding the collection of integrity data. Using an archived database of logged integrity observations at a residential school for children with brain injury, the authors sought to examine the degree to which integrity data collection conformed to best practices of behavioral assessment with respect to temporal sequencing. Moreover, due to the agency’s goal of collecting integrity on each student per month, the authors sought to examine whether the sequencing of integrity observations scalloped similarly to responding on conjunctive fixedinterval—fixed-ratio schedules. Results indicated that a majority of the staff exhibited some form of scalloping in their collection of integrity data. This article discusses possible sources of stimulus control and the potential for reactivity on the part of the teachers being observed when integrity observations are conducted in scalloped patterns. The authors conclude with a discussion on possible procedures to support the distributed collection of integrity data in applied setting.

Treatment of Co-Occurring Obsessive Compulsive Disorder and Social Phobia Through Exposure/Response Prevention and Cognitive Behavioral Therapy

We present a case report of exposure/response prevention and cognitive behavioral therapy for obsessive compulsive disorder (OCD) and social phobia in a 46-year-old man. The effects of both treatments were evaluated using standardized rating instruments and client self-monitoring. OCD and social phobia symptoms decreased with treatment, the man reported symptom relief, and results persisted post-treatment. Issues concerning treatment of co-occurring anxiety disorders are highlighted and discussed.

Effects of Nonverbal Social Disapproval on Attention-Maintained Spitting and Disruptive Vocalizing in a Child With Autism

This study addressed attention-maintained problem behaviors (spitting and disruptive vocalizing) of a child with autism. The intervention procedures consisted of service providers cleaning up the presence of saliva and demonstrating a “quiet” cue when the child spit and vocalized respectively. In two single-case reversal designs, the procedures reduced both behaviors to low frequency. Factors responsible for intervention success are discussed.