Pyramid training of elementary school teachers to use a classroom management "skill package"

ALFABETIZAÇÃO INICIAL VIA ENSINO SISTEMÁTICO PARA CRIANÇAS COM COMPORTAMENTOS EXTERNALIZANTES

RESUMO Comportamentos externalizantes como birra e agressividade são frequentemente concorrentes à aprendizagem acadêmica. A maior frequência de um comportamento em detrimento de outro pode indicar falhas no planejamento das condições de ensino. Verificou-se se três meninos, entre nove e 10 anos, com comportamentos externalizantes aferidos pelo instrumento TRF e não alfabetizados, aprenderiam leitura e escrita quando expostos ao ALEPP (Aprendendo a Ler e Escrever em Pequenos Passos). Programa de ensino com instrução baseada em equivalência e abordagem operacional de comportamentos simbólicos, com quatro unidades, divididas em 17 passos de ensino, precedidos e sucedidos por testes. Não houve intervenção sobre comportamentos externalizantes. Os resultados mostraram mais de 80% de acertos em leitura e escrita. Futuras pesquisas devem verificar a replicabilidade desses resultados com mais participantes e se a aquisição de repertórios acadêmicos afetaria a frequência de comportamentos externalizantes, considerando as habilidades do professor de reforçar repertórios acadêmicos em detrimento dos comportamentos externalizantes.

Interventionist Acquisition of Incidental Teaching Using Pyramidal Training via Telehealth

We investigated the effects of a telehealth pyramidal training package on participants' implementation of incidental teaching. A total of eight adults worked with eight children with autism. Coaches were first taught to implement incidental teaching and then taught subsequent interventionists. The training package consisted of an online module and delayed video-based feedback provided via videoconferencing. Following the telehealth training program, coaches and interventionists reached the preset performance criteria and implemented incidental teaching with high fidelity. All of the child participants increased mands above baseline levels. Results suggest that interventionists can be trained via telehealth in behavior analytic interventions.

Teaching Practitioners to Conduct Behavioral Skills Training: A Pyramidal Approach for Training Multiple Human Service Staff

A job responsibility of many behavior analysts that can involve significant amounts of time is training human service staff in behavior-change and related procedures. We evaluated a pyramidal approach using behavioral skills training (BST) for a trainer to train multiple staff. The BST skills of 10 practitioners in a human service setting were assessed as they trained a staff person in simulation before and after being trained (with BST) to conduct BST. Results indicated all participants improved their use of BST during the assessments following training and demonstrated proficient application of BST while training a staff person in the regular work setting. Acceptability measures suggested the training process was well received by the participants. Results are discussed regarding practical considerations with BST-based pyramidal training, including the conditions in which this training approach may be most advantageous.

A Review of the Pyramidal Training Approach for Practitioners Working With Individuals With Disabilities

Pyramidal training has been used for many years to expedite training for those who work with individuals with disabilities and utilizes an expert who provides training to a practitioner who then trains another practitioner to implement practices with clients. Fourteen articles were analyzed to investigate the viability of this training approach for practitioners of all types who support individuals with disabilities. Research does support the effectiveness of pyramidal training within the parameters with which it has been evaluated in this review. All Tier 1 participants made improvement; 83% of Tier 2 participants and 43% of individuals with disabilities showed improvement. Future researchers are encouraged to analyze not only the fidelity of the implementation of these practices but also the changes among the individuals with disabilities. To that end, progress monitoring is necessary to determine whether the implementation was the cause for the meaningful gains for the population being served.

Oral health educational interventions for nursing home staff and residents

BACKGROUND

Associations between nursing home residents' oral health status and quality of life, respiratory tract infections, and nutritional status have been reported. Educational interventions for nurses or residents, or both, focusing on knowledge and skills related to oral health management may have the potential to improve residents' oral health.

OBJECTIVES

To assess the effects of oral health educational interventions for nursing home staff or residents, or both, to maintain or improve the oral health of nursing home residents.

SEARCH METHODS

We searched the Cochrane Oral Health Trials Register (to 18 January 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2015, Issue 12), MEDLINE Ovid (1946 to 18 January 2016), Embase Ovid (1980 to 18 January 2016), CINAHL EBSCO (1937 to 18 January 2016), and Web of Science Conference Proceedings (1990 to 18 January 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 18 January 2016. In addition, we searched reference lists of identified articles and contacted experts in the field. We placed no restrictions on language or date of publication when searching the electronic databases.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and cluster-RCTs comparing oral health educational programmes for nursing staff or residents, or both with usual care or any other oral healthcare intervention.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened articles retrieved from the searches for relevance, extracted data from included studies, assessed risk of bias for each included study, and evaluated the overall quality of the evidence. We retrieved data about the development and evaluation processes of complex interventions on the basis of the Criteria for Reporting the Development and Evaluation of Complex Interventions in healthcare: revised guideline (CReDECI 2). We contacted authors of relevant studies for additional information.

MAIN RESULTS

We included nine RCTs involving 3253 nursing home residents in this review; seven of these trials used cluster randomisation. The mean resident age ranged from 78 to 86 years across studies, and most participants were women (more than 66% in all studies). The proportion of residents with dental protheses ranged from 62% to 87%, and the proportion of edentulous residents ranged from 32% to 90% across studies.Eight studies compared educational interventions with information and practical components versus (optimised) usual care, while the ninth study compared educational interventions with information only versus usual care. All interventions included educational sessions on oral health for nursing staff (five trials) or for both staff and residents (four trials), and used more than one active component. Follow-up of included studies ranged from three months to five years.No study showed overall low risk of bias. Four studies had a high risk of bias, and the other five studies were at unclear risk of bias.None of the trials assessed our predefined primary outcomes 'oral health' and 'oral health-related quality of life'. All trials assessed our third primary outcome, 'dental or denture plaque'. Meta-analyses showed no evidence of a difference between interventions and usual care for dental plaque (mean difference -0.04, 95% confidence interval (CI) -0.26 to 0.17; six trials; 437 participants; low quality evidence) or denture plaque (standardised mean difference -0.60, 95% CI -1.25 to 0.05; five trials; 816 participants; low quality evidence). None of the studies assessed adverse events of the intervention.

AUTHORS' CONCLUSIONS

We found insufficient evidence to draw robust conclusions about the effects of oral health educational interventions for nursing home staff and residents. We did not find evidence of meaningful effects of educational interventions on any measure of residents' oral health; however, the quality of the available evidence is low. More adequately powered and high-quality studies using relevant outcome measures are needed.

Procedures for Increasing Appropriate Verbal Participation in Special Elementary Classrooms

This study examined the effects of training in the use of a discussion leader "skill package" as a means of increasing the amount of appropriate verbal participation (AVP) by pupils. A multiple baseline design was used with three special elementary classrooms serving as multiple subjects. Five successive conditions were implemented: baseline, introductions, training in limit setting (basic skill training), training in back-up procedures plus shaping (basic skill training follow-up), and discussion leader training. Discussion leader training focused on skills for shaping student verbalizations that were relatively lengthy and of high quality, while maintaining classroom order. Results indicated that: (1) instructing teachers to maximize AVP resulted in no consistent changes in the dependent variables, (2) basic CMTP skill training reduced disruptions by over 80% in all three classrooms while increasing AVP, and (3) additional increases in AVP resulted from the specialized discussion leader training. Increases in AVP resulting from the combination of basic CMTP skill training and the specialized discussion leader training were 187%, 525%, and 1100% in the three participating classrooms, so that by the end of training students in all classrooms engaged in AVP between 33% and 42% of total class time. "Target" students selected prior to baseline as the quietest students in the three classes also increased AVP in proportion to the class as a whole.

Grandma's Rule with Group Contingencies—A Cost-Efficient Means of Classroom Management

A stop watch and a stop clock were utilized in two different versions of a classroom incentive program designed to reduce student disruptions and increase on-task behavior during a small group instructional format, in this case a reading circle. The present study investigated: (a) whether the two procedures would be effective in reducing disruptions and increasing task orientation among those students outside the reading circle who are relatively unsupervised by the teacher without being intrusive into the teacher's conducting his or her lesson and (b) whether the more expensive stop clock would be incrementally effective compared to the stop watch in order to justify the additional cost of the stop clock. A multiple baseline design with a reversal of the stop clock condition was employed with students of five regular elementary classrooms serving as subjects. Results indicated that both techniques reduced disruptions and that there was no systematic difference in effectiveness between the two procedures.

Teaching Survival English Skills and Assessment of Collateral Behavior

An ABAB reversal design was used to test the effects of contingent access to a language laboratory on the academic achievement and off-task behavior of a 16-year-old Spanish-speaking high school student. Contingencies were introduced following baseline, removed, and reintroduced only for correctly answering a series of life survival questions in English (e.g., What should one do in case of fire?). No contingencies were placed on collateral off-task responses. Coincident with initiation of contingent privileges, correct English answers changed from less than 40% to more than 85%. Performance decreased toward baseline levels during the reversal condition and again increased when training was reinstituted. Further, there was a negatively correlated change in each of five separate untreated off-task responses corresponding to changes in correct English answers. Among these, aggression and disruptive noise responses were decreased to zero with an increase in academic achievement. Thus, reinforcement contingencies for academic achievement were shown as effective for simultaneously teaching life-survival English skills and decreasing socially inappropriate behavior for a Spanish-speaking immigrant.

A sustainable model for training teachers to use pivotal response training

The increase in the rate of autism diagnoses has created a growing demand for teachers who are trained to use effective interventions. The train-the-trainer model, which involves training supervisors to train others, may be ideal for providing cost-effective training and ongoing support to teachers. Although research supports interventions, such as pivotal response training, as evidence-based, dissemination to school environments has been problematic. This study assessed the benefits of using the train-the-trainer model to disseminate pivotal response training to school settings. A multiple-baseline design was conducted across three training groups, each consisting of one school staff member (trainer), three special education teachers, and six students. Trainers conducted the teacher-training workshop with high adherence to training protocol and met mastery criteria in their ability to implement pivotal response training, assess implementation of pivotal response training, and provide feedback to teachers. Six of the nine teachers mastered all components of pivotal response training. The remaining three teachers implemented 89% of the pivotal response training components correctly. The majority of trainers and teachers maintained their abilities at follow-up. These results support the use of the train-the-trainer model as an effective method of disseminating evidence-based practices in school settings.

Provision of mouth-care in long-term care facilities: an educational trial

OBJECTIVES

This randomized clinical trial aimed to assess the effectiveness of a pyramid-based education for improving the oral health of elders in long-term care (LTC) facilities.

METHODS

Fourteen facilities matched for size were assigned randomly to an active or control group. At baseline in each facility, care-aides in the active group participated with a full-time nurse educator in a seminar about oral health care, and had unlimited access to the educator for oral health-related advice throughout the 3-month trial. Care-aides in the control group participated in a similar seminar with a dental hygienist but they received no additional advice. The residents in the facilities at baseline and after 3 months were examined clinically to measure their oral hygiene, gingival health, masticatory potential, Body Mass Index and Malnutrition Indicator Score, and asked to report on chewing difficulties.

RESULTS

Clinical measures after 3 months were not significantly different from baseline in either group, indicating that education neither influenced the oral health nor the dental hygiene of the residents.

CONCLUSIONS

A pyramid-based educational scheme with nurses and care-aides did not improve the oral health of frail elders in this urban sample of LTC facilities.

The problem of parental nonadherence in clinical behavior analysis: effective treatment is not enough

Applied behavior analysts have developed many effective interventions for common childhood problems and have repeatedly demonstrated that childhood behavior responds to properly managed contingencies. The success of these interventions is dependent upon their basic effectiveness, as demonstrated in the literature, their precise delivery by the clinician to the parent, and adherence to or consistent implementation of the intervention. Unfortunately, arranging the consistent implementation of effective parenting strategies is a significant challenge for behavior analysts who work in homes, schools, and outpatient or primary care clinics. Much has been done to address issues of adherence or implementation in the clinic, but relatively little has been done to increase our understanding of the contingencies that affect parental adherence beyond the supervised clinic environment. An analysis of the contingencies that strengthen or weaken adherence might suggest strategies to improve implementation outside the clinic setting. What follows is an analysis of the variables associated with adherence by parents to recommendations designed to solve common childhood problems.

A preventive dentistry training program for caretakers of persons with disabilities residing in community residential facilities

People with disabilities develop more dental disease than the average population and have a harder time accessing and using resources for dental treatment. It is therefore critical to prevent dental problems in this population. This article discusses the development and use of a preventive dentistry training program consisting of a videotape, workbook, instructions for trainers, and pre- and post-tests. The training program was designed to facilitate integration of dental and behavioral information into daily routines. Participants were able to demonstrate that they could learn the information in the training materials using the methodology that was employed. Further work remains to be done to revise and disseminate the materials and to demonstrate that the knowledge that the participants gained can be effectively applied in community care settings.

Increasing nurses' use of feedback to promote infection-control practices in a head-injury treatment center

This study established regular implementation of a simple feedback procedure by supervisory nurses with their assistants at a head-injury treatment center. Five nurses were trained to distribute brief written comments to their assistants about infection-control practices, including using gloves to avoid contact with body fluids. Following low rates of written feedback, nurses met with the trainer weekly to set goals for using the system, to review feedback rates, and to examine contingent letters of appreciation. Written feedback increased from 0.09 to 0.58 per day. When outcome data on glove use were subsequently added to the feedback provided to nurses, nurses' feedback on glove use increased and overall glove use by assistants increased by 36.7% for 66.7% of assistants who responded to feedback. Assistants rated feedback as highly accurate and indicated some interest in receiving future feedback. However, nurses and assistants expressed a preference for oral over written feedback.

Increasing implementation of special education instruction in mainstream preschools: direct and generalized effects of nondirective consultation

Two studies evaluated a consultation strategy for increasing teachers' implementation of instruction related to specific Individualized Education Plan objectives for handicapped children mainstreamed into regular preschool programs. In the first study, teachers viewed videotaped sequences of regular classroom routines and were asked to generate ideas for embedding IEP-related instruction into those routines. All teachers demonstrated increases in instructional behaviors in targeted routines, and 2 of the 3 teachers increased instruction in additional settings that had not been the focus of the consultation. Children demonstrated concomitant increases in IEP-targeted behaviors. In follow-up questionnaires and interviews, teachers reported increased confidence in their ability to implement specialized instruction. These findings were replicated in a second study in which the videotaping was replaced by teacher interview, and in which the consultation was carried out by a previously untrained special education teacher.

The use of picture programs in teaching direct care staff

Direct care staff were taught via picture programs to transfer nonambulatory, severely mentally retarded men between their beds and wheelchairs. Still color photographs illustrated essential details of the complex behavior sequences. Staff transferring performance improved markedly over that shown on a pretest. Study guide questions increased the effectiveness of the programs, perhaps because the questions encouraged accurate observation of the pictures. The procedures may suggest cost effective alternatives to traditional forms of inservice training.

A supervision program for increasing functional activities for severely handicapped students in a residential setting

This study was designed to increase the amount of time severely handicapped students living in a residential facility engaged in age-appropriate and functional activities. After a brief in-service training, a program involving instructions to supervisors and staff feedback was implemented in a multiple-baseline design across settings. Results showed that after the supervision program was implemented, the students' participation in activities increased. Further, these increases maintained when feedback was reduced from an average of 3 days a week during treatment, to once a month for a 5-month period.

Peer training of safety-related skills to institutional staff: benefits for trainers and trainees

A peer training program, in which experienced staff trained new staff, was evaluated as a method for teaching and maintaining safety-related caregiver skills in an institutional setting for the developmentally disabled. Three sets of safety-type skills were assessed in simulated emergency situations: responding to facility fires, managing aggressive attacks by residents, and assisting residents during convulsive seizures. Using a multiple-baseline research design, results indicated that the peer training program was an effective method of training the three types of emergency skills to new direct care staff. The program also appeared effective in improving the skills of the peer trainers. Perhaps most importantly, results indicated that if experienced staff functioned as peer trainers for particular emergency skills, then their proficiency in those skills maintained over time whereas their proficiency declined in emergency skills for which they did not act as peer trainers. Social validity information collected from available staff 23 months after the program was completed supported the utility of the training in terms of staff responses during actual emergencies. Also, acceptability measures indicated that staff liked participating in the program. However, some inconsistencies between staff verbal reports and performance-based measures of acceptability were noted. Results are discussed regarding the overall effectiveness of the peer training program, the importance of maintenance strategies for safety-related skills, and the need for multidimensional analyses of staff acceptability in staff training/management research.

Pyramidal training: a large-scale application with institutional staff

This study evaluated an indirect method of training 45 institutional direct care staff to conduct behavioral programs. Three supervisors were trained to improve teaching behaviors (instructions, prompts, and consequence) used by the direct care staff while working with severely and profoundly handicapped residents. In addition to training, daily feedback was provided to supervisors regarding performance of their staff. Results of a multiple baseline analysis across teaching behaviors (instructions, prompts, and consequences) and content areas (communication and gross motor skills) showed that providing training and feedback to supervisors resulted in increases in correct teaching behavior by direct care staff. However, teaching behavior newly learned in one content area (communication) did not generalize to the other area (gross motor skills). Data collected on resident behavior showed small but noticeable improvement in terms of correct responses and attending behavior during programming. Results are discussed in terms of the benefits of a pyramidal approach to training institutional staff.