The necessity of examining patients' social behavior and teaching behavior change theories: curricular innovations induced by the COVID-19 pandemic

During the COVID-19 pandemic, despite many widespread calls for social distancing, recommendations have not been followed by some people and the high rate of non-compliance has significantly affected lives all around the world. It seems that the rate of non-compliance with the recommendations among medical students has been as high as the rest of the other youth. In the time that students are removed from clinical environments and most physician teachers are strained in providing services to patients, medical students can be trained in interdisciplinary behavior change counseling programs and they can be employed in delivering virtual consultations to the patients referred to medical centers.In this quick review, we provide an argument regarding the importance of integrating the topic of patients' social history into the undergraduate medical curriculum and the necessity of teaching theories of behavior change to medical students. Hypotheses are proposed that focus on the importance of integrating behavioral and social sciences into the medical curriculum and to teach theories or models of behavior change to students. Health professions educators can design and implement interventions to teach hypothesized models of behavioral change to medical students and evaluate the effectiveness of those interventions. The impacts of such educational interventions on increasing people's compliance with recommendations to improve public health can be evaluated as well.

The effects of a short-term physician training on smoking cessation in a university pulmonary department

Objective: The objective was to evaluate the effect of a short physician training in smoking cessation on the physicians' performance of smoking cessation interventions. The effects on patients' cessation rates were analyzed as well. A further aim was to identify barriers for providing cessation interventions. The study was conducted in an acute care pulmonology department of a German university hospital. Methods: 24 physicians of the pulmonology department of a German university hospital received a two-hour training in smoking cessation. 109 pre- and 89 post-training group patients were compared with regard to the frequencies of received smoking cessation interventions (Ask, Advise, Assist) and three- and six-month abstinence rates. Physicians estimated their intervention frequencies and gave reasons for not providing cessation interventions. Results: In a multivariable analysis (p<0.05), the physicians' application of "Ask" (OR 3.28, 95% CI 1.13-9.53) and the six-month abstinence rates (OR 2.70, 95% CI 1.24-5.84) were significantly higher in the post-training group. The univariate analysis also showed a significant effect on "Assist" (OR 2.05, 95% CI 1.09-3.87). No significant effect was seen on "Advise to quit". Physicians overestimated their intervention frequencies and reported the patients' low motivation to stop, an oncological disease and palliative care situation as barriers to performing smoking cessation. Conclusion: A short physician training in a hospital department of pulmonology increases the use of guideline-based cessation strategies and may improve cessation rates. The findings show that hospital-based strategies such as physician trainings could be useful in the improvement of smoking cessation. Strategies for overcoming barriers for providing smoking cessation interventions are needed.

The change in the intensity of symptoms in children and adolescents with attention deficit hyperactivity disorder after "Workshops for Parents of Hyperactive Children"

OBJECTIVES

To evaluate changes in the intensity of ADHD symptoms and size effects after the completion of the twelve-week "Workshops for Parents of Hyperactive Children".

METHODS

Intervention group included parents (N = 199) of children and adolescents diagnosed with ADHD, who completed the twelve-week parental training. The reference group included parents (N = 24) of children and adolescents diagnosed with ADHD, who received 1-2 standard psychiatric visits within twelve weeks (treatment-as-usual). The following questionnaires were completed by the participants at the beginning and at the end of the training: CBCLand Conners-IOWA-10 (parent's assessment of the child), TRF and Conners-RCTRS-28 (assessment of the child by the teacher/educator), and YSR (in children of 11 years and over). The same diagnostic regime was used in the reference group - the patients were assessed during the first visit and after twelve weeks.

RESULTS

The majority of attendees were parents of boys diagnosed with: ADHD mixed type with or without ODD and ADHD predominantly inattentive type. The intervention resulted in significant reduction of inattentive-impulsive-hyperactive and oppositional-defiant symptoms in Conners-IOWA-10 and significant reduction of symptoms in the following CBCL scales: "Social problems", "Attention problems", "Aggressive behavior", "Externalizing behavior", as well as the overall score, as rated by mothers. The improvement was age, diagnosis and pharmacotherapy independent.

CONCLUSIONS

The therapeutic program used in our study resulted in small to moderate reduction of symptoms in children and adolescents with attention deficit hyperactivity disorder irrespective of subtype, comorbid disorders or pharmacotherapy (if implemented).

Competitive Development Tools in Identifying Efficient Educational Interventions for Improving Pro-Environmental and Recycling Behavior

Daily life in today’s dynamic world requires fast adaptation of people’s behavior to new challenges emerged from environmental, health, urban housing, transportation, etc. problems. A strong and complex tool in changing behaviors, education consumes significant resources and requires time for effective impact. The present study proposes a roadmap, integrating advanced methods for industrial competitive development (QFD) in configuring efficient educational interventions for changing people’s behavior on special thematic areas, such as environment and recycling. A literature review on applicable behavioral theories led to more than 30 behavioral factors (constructs) targetable by education, their specific impact evaluation being the subject of a survey among education professionals. Finally, to reach a mapping of efficient interventions with low costs, high impact and fast results criteria, educational interventions and behavioral factors were correlated by the QFD method on three dimensions addressing: teachers and trainers, contents and tools, respectively the national & institutional level. The current research results are focused particularly on changing recycling behaviors, but the overall concept and methodology can be expanded to incorporate any preoccupation in the areas of environment and health, as long-term drivers of public well-being.

Behavior change counseling training programs for nurses and nursing students: A systematic descriptive review

OBJECTIVES

(1) To systematically review the literature on behavior change counseling (BCC) training programs targeting nurses and nursing students; (2) to characterize these training programs according to their content (i.e., targeted health behavior[s], BCC approaches taught, BCC techniques taught), structure, and modes of delivery.

DESIGN

A systematic, descriptive literature review.

DATA SOURCES

PubMed, CINAHL and Embase were searched with no time limitation in August 2018.

REVIEW METHODS

A systematic, descriptive literature review structured according to Paré et al.'s methodology and the PRISMA guidelines. Primary studies were included if they evaluated a BCC training program with nurses or nursing students. Review authors screened studies, extracted data, and assessed study quality using the MERSQI. Data was synthesized through narrative synthesis, descriptive statistics, and content analysis.

RESULTS

From a pool of 267 articles, we included 25 articles published between 2003 and 2018. Two studies scored as low quality (8%), 18 as moderate quality (72%), and 5 as high quality (20%). Physical activity (n = 14; 56%) and smoking (n = 11; 44%) were the most frequently targeted health behaviors. Eleven BCC approaches were cited (e.g., motivational interviewing), and 48 BCC techniques were identified (e.g., eliciting and scaling change talk). The median number of training sessions was 3 (interquartile range [IQR] 5), the median training program duration was 3 h (IQR 6.25 h), and median training period was 24.5 days (IQR 110 days). Programs were most often delivered as seminars and workshops.

CONCLUSIONS

High-quality studies reporting the assessment of BCC training programs with nurses and nursing students are scarce. There was significant heterogeneity in terms of the BCC approaches and techniques taught. Current evidence suggests nurses and nursing students learn BCC mainly through active, realistic practice. However, computer-based training programs are rapidly gaining ground. Further research emphasizing theory-based BCC training programs is warranted.

Efficacy of Transdiagnostic Behavior Therapy Across the Affective Disorders

This study supports the efficacy of transdiagnostic behavior therapy across various affective disorders, including depression and PTSD. These findings suggest a possible reduction in the number of treatment protocols providers need to learn in order to treat patients with affective disorders.

Integrating behaviour change counselling into chronic disease management: a square peg in a round hole? A system-level exploration in primary health care

OBJECTIVES

The objective of this study is to evaluate the uptake of competency-based behaviour change counselling training within a primary healthcare setting. Specific questions concerning provider readiness for training, perceived importance of training in the context of service demands and perceptions of competence after training were addressed.

STUDY DESIGN

A process-focused study which adopted a complex systems approach to implementation. Each step was evaluated before the next step was developed. The design was guided by the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework.

METHODS

Four specific primary care services were identified and behaviour change counselling training tailored to each service was provided, based on a model of training built around competencies in establishing change-based relationships, assessing and promoting readiness to change, using evidence-based behaviour modification skills when ready and addressing psychosocial determinants of behaviour within scope of practice. Before training, a manager's readiness to facilitate training and identification of peer leaders to support ongoing practice of skills were completed.

RESULTS

Two programs negotiated 8 h of formal training, one program received 10 h and one program received 12 h. All programs engaged in peer support activities. Despite willingness to support training, 90% of managers were ambivalent about training activities, relative to one half of healthcare providers (HCPs). Few HCPs and no managers self-identified as ready without ambivalence. Furthermore, HCPs were reluctant to be evaluated by an expert and preferred self-evaluation methods. In contrast, HCPs uniformly endorsed the relevance, value and professional commitment to all component skills of the behaviour change counselling model. At the end of the training, over 75% of staff reported receiving formal training (reach). Almost 80% of staff reported using change-based relationship skills daily, with less frequent use of skills associated with addressing psychosocial issues. The degree of corrective feedback was generally low, however. An index of competency based on formal training, frequent use and receiving corrective feedback indicated that most HCPs did not meet these criteria.

CONCLUSION

Training in behaviour change counselling competencies was successfully implemented in this project. The vast majority of HCPs received training, despite ambivalence. Furthermore, HCPs strongly valued these skills and used them frequently. However, they were reluctant to accept corrective feedback. Future research is needed to evaluate innovative strategies to overcome obstacles to receiving corrective feedback in the use of behaviour change counselling skills.

"A change would do you good": Training medical students in Motivational Interviewing using a blended-learning approach - A pilot evaluation

Objectives This study aims to assess medical students' interest in a Motivational Interviewing (MI), the objective need for a special training, and students' satisfaction with and the effectiveness of such a course. Methods A mandatory MI course was implemented for sixth-semester medical students. Their interest in learning MI was evaluated, along with their satisfaction with the course, which was delivered in a blended-learning teaching approach. Participants' baseline MI skills and general communication skills were assessed. MI non-adherent behavior, like persuading and confronting patients, was noted. Successful learning was measured with a multiple-choice test administered before and after the course that assessed subjective knowledge and skills. Results Students were highly interested in learning MI. At baseline, they showed good communication skills but moderate MI skills. Satisfaction with the course was high. The course was effective, as subjective and objective knowledge and skills improved significantly. Conclusions This pilot study suggests that basic MI skills can be successfully taught in a blended-learning teaching approach. Further research should investigate sustainability and transfer to clinical practice. Practice implications Medical schools should consider providing students with special training in MI to help students counsel patients towards behavioral changes.

Training physicians in behavioural change counseling: A systematic review

BACKGROUND

Poor health behaviours (e.g., smoking, physical inactivity) represent major underlying causes of non-communicable chronic diseases (NCDs). Prescriptive behaviour change interventions employed by physicians show limited effectiveness. Physician training in evidence-based behaviour change counselling (BCC) may improve behavioural risk factor management, but the efficacy and feasibility of current programs remains unclear.

OBJECTIVE

(1) To systematically review the efficacy of BCC training programs for physicians, and (2) to describe program content, dose and structure, informing better design and dissemination.

METHODS

Using PRISMA guidelines, a database search up to January 2018, yielded 1889 unique articles, screened by 2 authors; 9 studies met inclusion criteria and were retained for analysis.

RESULTS

100% of studies reported significant improvements in BCC skills among physicians, most programs targeting provider-patient collaboration, supporting patient autonomy, and use of open questions to elicit "change-talk". Limitation included: poor reporting quality, high program heterogeneity, small sample sizes, 78% of studies having no comparison group, and less than 30% of skills taught being formally assessed.

CONCLUSION

Training programs were efficacious, but methodological weaknesses limit the ability to determine content and delivery. Caution is necessary when interpreting the results.

PRACTICE IMPLICATIONS

Further research emphasizing rigorous training program development and testing is warranted.

System-integrated technology-enabled model of care to improve the health of stroke patients in rural China: protocol for SINEMA-a cluster-randomized controlled trial

BACKGROUND

Despite the significant burden of stroke in rural China, secondary prevention of stroke is suboptimal. This study aims to develop a SINEMA for the secondary prevention of stroke in rural China and to evaluate the effectiveness of the model compared with usual care.

METHODS

The SINEMA model is being implemented and evaluated through a 1-year cluster-randomized controlled trial in Nanhe County, Hebei Province in China. Fifty villages from 5 townships are randomized in a 1:1 ratio to either the intervention or the control arm (usual care) with a target to enroll 25 stroke survivors per village. Village doctors in the intervention arm (1) receive systematic cascade training by stroke specialists on clinical guidelines, essential medicines and behavior change; (2) conduct monthly follow-up visits with the support of a mobile phone application designed for this study; (3) participate in virtual group activities with other village doctors; 4) receive performance feedback and payment. Stroke survivors participate in a health education and project briefing session, receive monthly follow-up visits by village doctors and receive a voice message call daily as reminders for medication use and physical activities. Baseline and 1-year follow-up survey will be conducted in all villages by trained staff who are blinded of the randomized allocation of villages. The primary outcome will be systolic blood pressure and the secondary outcomes will include diastolic blood pressure, medication adherence, mobility, physical activity level and quality of life. Process and economic evaluation will also be conducted.

DISCUSSION

This study is one of very few that aim to promote secondary prevention of stroke in resource-constrained settings and the first to incorporate mobile technologies for both healthcare providers and patients in China. The SINEMA model is innovative as it builds the capacity of primary healthcare workers in the rural area, uses mobile health technologies at the point of care, and addresses critical health needs for a vulnerable community-dwelling patient group. The findings of the study will provide translational evidence for other resource-constrained settings in developing strategies for the secondary prevention of stroke.

Effectiveness of training final-year undergraduate nutritionists in motivational interviewing

OBJECTIVES

To assess the efficacy of a motivational interviewing (MI) training programme on trainee nutritionists.

METHODS

A repeated measures design was applied to assess clinician behaviours in a 'helping' conversation. Participants were 32 nutrition students, assessed at baseline and one-month follow-up.

RESULTS

The training significantly reduced the use of closed questions and MI non-adherent behaviours (MINA) (P for both=<0.001). Trainees significantly increased reflections, affirmations, summaries (P for all=<0.001) and the use of open questions (P=<0.013) which are all key indicators of MI beginner-competence. The talk-time ratio of the nutritionists also changed significantly, in favour of the client which serves as an indication of MI being used effectively. There were also significant increases in 'global' scores for empathy, direction, autonomy/support, collaboration and evocation.

CONCLUSIONS

Newly trained nutritionists 1 month post-training have a consultation style which suggested positive outcomes for clients. The trainees' scores at the one month post-training assessment were verifiable as 'beginning proficiency'.

PRACTICE IMPLICATIONS

Behaviour change counselling skills for nutritionists were enhanced, at one month post-training. MI training workshops with video feedback enhances communication skills which are likely to lead to positive consultation-behaviour changes in the trainee nutritionists.

A Controlled Trial to Reduce the Risk of Human Nipah Virus Exposure in Bangladesh

Human Nipah virus (NiV) infection, often fatal in Bangladesh, is primarily transmitted by drinking raw date palm sap contaminated by Pteropus bats. We assessed the impact of a behavior change communication intervention on reducing consumption of potentially NiV-contaminated raw sap. During the 2012-2014 sap harvesting seasons, we implemented interventions in two areas and compared results with a control area. In one area, we disseminated a "do not drink raw sap" message and, in the other area, encouraged only drinking sap if it had been protected from bat contamination by a barrier ("only safe sap"). Post-intervention, 40% more respondents in both intervention areas reported knowing about a disease contracted through raw sap consumption compared with control. Reported raw sap consumption decreased in all areas. The reductions in the intervention areas were not significantly greater compared to the control. Respondents directly exposed to the "only safe sap" message were more likely to report consuming raw sap from a protected source than those with no exposure (25 vs. 15%, OR 2.0, 95% CI 1.5-2.6, P < 0.001). While the intervention increased knowledge in both intervention areas, the "only safe sap" intervention reduced exposure to potentially NiV-contaminated sap and should be considered for future dissemination.

Is There a Scale-up Penalty? Testing Behavioral Change in the Scaling up of Parent Management Training in Norway

In the present study, the scaling up of Parent Management Training, Oregon Model (PMTO) in Norway was examined by investigating how large-scale dissemination affected the composition of the target group and the service providers by comparing child behavioral outcomes in the effectiveness and dissemination phases of implementation. Despite the larger heterogeneity of the service providers and the intake characteristics of the target group, which are contrary to the expectations that were derived from the literature, no attenuation of program effects was detected when scaling up PMTO. In Norway, a long-term-funded centralized center, combined with an active implementation strategy, seems to have affected the quality of PMTO delivered system-wide in services for children with behavior problems.

Teaching Dialectical Behavior Therapy to Psychiatry Residents: The Columbia Psychiatry Residency DBT Curriculum

OBJECTIVE

Dialectical behavior therapy (DBT) is an evidence-based psychosocial treatment with efficacy in reducing self-harm behaviors in borderline personality disorder (BPD). This study describes and evaluates a clinical curriculum to teach DBT to psychiatry residents, developed at a large urban university hospital. The curriculum objectives are to (1) have psychiatry residents achieve basic understanding of DBT theory and clinical skill, (2) increase residents' ability and confidence in treating self-harm behaviors (both suicidal behavior and non-suicidal self-injury), and (3) enhance residents' willingness to treat individuals with BPD.

METHODS

In addition to a 6-week didactic course on DBT offered to all residents (n = 62), 25 elected to enroll in a year-long DBT clinical training curriculum over the course of a 5-year period. The DBT clinical training consisted of 15 h of additional didactics, ongoing conduct of individual therapy and group DBT skills training, videotaping of individual therapy sessions, and weekly supervision meetings utilizing videotape to provide feedback. Residents participating in the clinical training program videotaped baseline and later sessions, which were rated for DBT adherence. All 62 graduates of the program were surveyed regarding the impact of the training on their practice of psychiatry.

RESULTS

Upon graduation, a high percentage (87 % in the curriculum and 70 % in the didactic course only) reported incorporating DBT into their psychiatry practice, as well as willingness and confidence in treating BPD and self-harm behaviors. Residents participating in the clinical training demonstrated significant improvement in their ability to utilize DBT interventions, particularly in structuring sessions, problem assessment, problem solving, and using validation and dialectical strategies.

CONCLUSION

This DBT curriculum was effective in preparing psychiatrists-in-training to incorporate evidence-based practices for effective treatment of BPD and self-harm behaviors and can serve as a model for teaching DBT during psychiatry residency training. Limitations include a small sample size and lack of baseline survey measurement of attitudes for pre- and post-curriculum comparison.

Does Nursing Facility Use of Habilitation Therapy Improve Performance on Quality Measures?

The purpose of the project, Centers for Medicare & Medicaid Services (CMS) Innovation study, was to evaluate the impact on 12 quality measures including 10 Minimum Data Set (MDS) publicly reported measures and 2 nursing home process measures using habilitation therapy techniques and a behavior team to manage dementia-related behaviors. A prospective design was used to assess the changes in the measures. A total of 30 Massachusetts nursing homes participated in the project over a 12-month period. Project participation required the creation of an interdisciplinary behavior team, habilitation therapy training, facility visit by the program coordinator, attendance at bimonthly support and sharing calls, and monthly collection of process measure data. Participating facilities showed improvement in 9 of the 12 reported measures. Findings indicate potential quality improvement in having nursing homes learn habilitation therapy techniques and know how to use the interdisciplinary team to manage problem behaviors.

Using Health Education Theories to Explain Behavior Change: A Cross-Country Analysis

Scholars within the fields of public health, health education, health promotion, and health communication look to specific theories to explain health behavior change. The purpose of this article is to critically compare four health theories and key variables within them with regard to behavior change in the area of reproductive health. Using cross-country analyses of Ghana, Nepal, and Nicaragua (data sets provided by the Center for Communication Programs, Johns Hopkins University), the authors looked at the Health Belief Model, Theory of Reasoned Action, Extended Parallel Process Model, and Social Cognitive Theory for these two defined objectives. Results show that all four theories provide an excellent fit to the data, but that certain variables within them may have particular value for understanding specific aspects of behavior change. Recommendations for the selection of theories to use as guidelines in the design and evaluation of reproductive health programs are provided.

A Comparison of Effectiveness of Parent Behavioral Management Training and Methylphenidate on Reduction of Symptomsof Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is one of the most common psychological disorders of childhood. Methylphenidate is highly effective in the treatment of ADHD. This study aimed to determine the effectiveness of combined Parent behavioral management training (PBMT) and medication treatment (Methylphenidate) in reducing ADHD symptoms in 6-12-year-old children, using randomized sampling. A total of 50 children with ADHD were assigned into two groups: an experimental group of PBMT and a control group of medication treatment (Methylphenidate) without other interventions. Conners' Parent Rating Scale (CPRS-48) was employed before and after interventions to determine the effects. Descriptive Statistics method (consisting of Mean and Standard deviation) and Statistical inference method, (including t-test and Levene's Test) were used for data analysis.  Findings revealed that the combined behavioral intervention of PBMT and methylphenidate treatment is more effective in reduction of ADHD in children. The difference of means between pre-test and post-test of CPRS in the experimental group was equal to 10.77, and it was equal to 1.88 in the control group. In addition, PBMT was more effective in the case of younger parents (P<0.025). However, parents' education level did not affect the behavioral intervention (P<0.025).The findings suggest that combined intervention of PBMT and methylphenidate is effective in reducing the symptoms of ADHD in children.

Enhancing Treatment Team Process Through Mindfulness-Based Mentoring in an Inpatient Psychiatric Hospital

The authors investigated changes in treatment team functioning in an adult inpatient psychiatric hospital after the implementation of a mindfulness-based mentoring intervention. Using a multiple baseline across treatment teams design, the authors assessed levels of functioning of three treatment teams using a 50-item rating scale and then introduced mindfulness-based mentoring successively across the treatment teams. Following intervention, four follow-up assessments at 3-month intervals were undertaken to assess the durability of the enhanced treatment team functioning levels in the absence of mentoring. Results showed that with the introduction of mindfulness-based mentoring, treatment team performance was enhanced, patients'attendance at therapeutic groups and individual therapy sessions was maximized, and patient and staff satisfaction with treatment team functioning was substantially increased, with patient satisfaction showing greater gains than staff satisfaction. Mindfulness-based mentoring may be an efficient and effective intervention for enhancing and maintaining the performance of treatment teams in adult psychiatric hospitals.

Barriers and solutions to implementing dialectical behavior therapy in a public behavioral health system

Dialectical behavior therapy (DBT) is an evidence-based treatment that is considered to be the standard of care in treating individuals with BPD, however there have been few published studies to identify the challenges and solutions for implementing DBT in community-based settings. The current study identified the barriers and solutions within a system-wide roll-out of DBT within a large, urban public health system encompassing both mental health and substance abuse treatment settings. Qualitative interviews were conducted with 19 clinicians receiving DBT training over a period of 13 months. A content analysis revealed three themes that were identified as challenges to the DBT implementation process including program development and recruitment of patients, a lack of administrative support or organizational investment in DBT, and time commitment of DBT. In order to transfer DBT into a public behavioral health system, investment from both clinic- and system-level administrators is required. Strategies to prevent drift, such as incorporating a train-the-trainer model, are discussed.

Parent Training in Autism Spectrum Disorder: What's in a Name?

Parent training (PT) is well understood as an evidence-based treatment for typically developing children with disruptive behavior. Within the field of autism spectrum disorder (ASD), the term parent training has been used to describe a wide range of interventions including care coordination, psychoeducation, treatments for language or social development, as well as programs designed to address maladaptive behaviors. As a result, the meaning of "parent training" in ASD is profoundly uncertain. This paper describes the need to delineate the variants of PT in ASD and offers a coherent taxonomy. Uniform characterization of PT programs can facilitate communication with families, professionals, administrators, and third-party payers. Moreover, it may also serve as a framework for comparing and contrasting PT programs. In support of the taxonomy, a purposive sampling of the literature is presented to illustrate the range of parent training interventions in ASD.

Promoting Shared Decision Making to strengthen outcome of young children with Autism Spectrum Disorders: the role of staff competence

Little is known on how the conceptual description of Shared Decision Making (SDM) accomplishes clinical practice in the context of lifetime disabilities as in particular Autism Spectrum Disorders (ASD), when intervention is long-lasting and requires constant family involvement. This study aimed mainly to investigate to what extent the staff's competence in SDM contributes to positive child and parent improvement when involving parents in Early Intensive Behavior Interventions (EIBI). It was also geared to verify whether SDM staff competence contributes to a child's treatment responsiveness. A total of 25 young children with ASD (23 male, 3 female, age range 34-92 months, mean age 51.4±13.6) were included in the study. Of these, nine children were allocated to a Parent Involvement condition accompanied by SDM Staff Training (PI-SDM), and eight children to a Parent Inclusion in Treatment Delivery Only condition without SDM Staff Training (PI-DO). Nine months treatment outcomes of severity, developmental and adaptive measures were compared to Treatment As Usual (n=8). PI-SDM was associated with improvement of autistic symptoms (p≤.05), adaptive functioning (p≤.01) and developmental outcome (p≤.01), as well as parent (p≤.05) and staff competence (p≤.001). The magnitude of outcome was inferior in the PI-PO and TAU group. A Reliable Change was identified in more than 40% of children included in PI-SDM, while PI-PO (>20%) and TAU (>12%) let to little Reliable Change and partially skill deterioration. Staff's SDM skill competence predicts reduced parental stress (β=-.500, p≤.05) and contributes significantly to a positive treatment responder trajectory (p≤.01), besides lower severity (p≤.05), higher adaptive (p≤.01) and communication skills (p≤.05). The study indicates that parent inclusion should be conceptualized as a collaborative partnership model rather than as adherence in treatment provision, based on a target SDM staff training that may constitute an external contributor to treatment responsiveness and positive child as well as parent outcome.

Effects of parent management training programs on disruptive behavior for children with a developmental disability: a meta-analysis

This meta-analysis determined the effects of parent management training (PMT) on disruptive behaviors in children with a developmental disability. Parent management training programs, based on behavioral theories of psychology, are commonly used in addressing disruptive behavior in children. Eleven studies met inclusion criteria with a total of 540 participants, with 275 in experimental groups and 265 in control groups. The effect of PMT on the disruptive behavior in children with a developmental disability was significant (g=0.39). The moderator effects of type of PMT, delivery type and setting, and administrator level of education were also significant. The moderator effects of child age, and session number and duration were not significant in this meta-analysis.

Comparison of standardized patients and real patients as an experiential teaching strategy in a nutrition counseling course for dietetic students

OBJECTIVES

To compare the quality of communication and behavioral change skills among dietetic students having two nutrition encounters with either a real patient or a standardized patient in the simulation laboratory at Drexel University, Philadelphia, PA, United States.

METHODS

A retrospective analysis of video recordings (n=138) containing nutrition encounters of dietetic students (n=75) meeting with a standardized patient (SP) or a real patient (RP). Trained raters evaluated communication skills with the 28 item Calgary Cambridge Observation Guide (CCOG) and skills promoting behavior change using the 11 item Behavior Change Counseling Index (BECCI) tool.

RESULTS

Using the CCOG, there was a significantly greater mean score in the SP group for the category of "Gathering Information" in encounter one (p=0.020). There were good to excellent ratings in all categories of the CCOG and the BECCI scores for the SP and the RP groups at both encounters. There was no significant differences in change scores from encounter one to encounter two between groups.

CONCLUSIONS

Encounters with SPs and RPs are both effective strategies for dietetic students to demonstrate their communication and behavior change skills.

PRACTICE IMPLICATIONS

Utilizing SPs is an effective experiential strategy for nutrition counseling curricula.

Evaluation of a continuing education course for occupational therapy practitioners on the use of applied behavior analysis

A three hour continuing education course combining occupational therapy practice and behavior analysis strategies related to children with autism spectrum disorders was developed and delivered to 24 occupational therapy practitioners. Participants completed evaluations pre-course, post-course, and one month follow up on their self-efficacy, knowledge, and skills in managing challenging behaviors of children with autism spectrum disorders. Overall, ratings scores showed an increase in participants' self-efficacy and knowledge and skill at post-course and one-month follow-up. Despite this increase, participants continued to implement sensory strategies to decrease challenging behaviors due to increased self-efficacy in using sensory strategies and the lack of support in implementing behavior techniques outside their session time.

Managing the ‘unmanageable’: Training staff in the use of dialectical behaviour therapy for borderline personality disorder

Ninety-four staff from a regionally based mental health service and associated health and human services completed a two-day workshop introducing dialectical behaviour therapy, with a smaller number also undertaking advanced training. Survey and focus group data were collected on participants' demographics, attitudes, knowledge and experience of working with persons with this disorder, prior to and at one-month and six-months following completion of the introductory workshops. Quantitative and qualitative findings indicated that involvement in the training program was a positive experience for the majority of participants, with knowledge regarding detection and treatment and staff attitudes toward consumers being improved following exposure to the principles and practice of dialectical behaviour therapy. Discourse analysis of the focus group interview data pre- and post-training indicated a significant shift in the meanings staff associate with borderline personality disorder, with a pervasive therapeutic pessimism being displaced by more optimistic understandings and outlooks. Improved therapeutic outlook is likely to have positive implications for staff engagement with service users with borderline personality disorder. While this article provides a brief overview of the findings of the survey, the main purpose is to report the findings of the focus group interviews.

Behavior management for preschool-aged children

This article summarizes behavior management strategies for preschool children who are at high risk for attention-deficit/hyperactivity disorder that have found to be effective in improving child behavior. Both parent and teacher training programs are reviewed, as these have been backed by substantial research evidence. In addition, multimodal treatments that include some combination of parent training, teacher training, and social skills training are also reviewed. Interventions emphasize the need for a strong adult-child relationship combined with proactive behavior management strategies to improve child behavior.

Train the trainer effectiveness trials of behavioral intervention for individuals with autism: a systematic review

This systematic review examines train the trainer (TTT) effectiveness trials of behavioral interventions for individuals with autism spectrum disorder (ASD). Published methodological quality scales were used to assess studies including participant description, research design, intervention, outcomes, and analysis. Twelve studies including 9 weak quality quasi-experimental studies, 2 single-subject experimental design studies of moderate and weak quality, and 1 high quality randomized control trial were included. Overall, author reported effect sizes and calculation of improvement rate difference for SSRDs indicate positive effects of intervention across participant outcomes including cognition, language, and autism symptoms postcommunity delivered interventions primarily based in applied behavior analysis. Effects varied by children's developmental level.

Training residential staff and supervisors to conduct traditional functional analyses

In this study we extended a training outlined by Iwata to behavioral technicians working for a residential service provider for adults with developmental disabilities. Specifically, we trained ten supervisors and four assistants to organize, conduct, collect data for, and interpret the results of traditional functional analyses (FA; Iwata et al.,1994). Performance was initially low and improved across all measures following training. Results extend previous FA training research by including a tangible condition and by demonstrating that individuals with little to no prior experience conducting FAs can be taught all of the skills required to autonomously conduct them in a relatively short period of time.

Evaluation of an implementation initiative for embedding Dialectical Behavior Therapy in community settings

We examined the effectiveness of Dialectical Behavior Therapy (DBT) training in community-based agencies. Data were gathered at four time points over a 2-year period from front-line mental health therapists (N=64) from 10 community-based agencies that participated in a DBT implementation initiative. We examined change on therapist attitudes toward consumers with Borderline Personality Disorder (BPD), confidence in the effectiveness of DBT, and use of DBT model components. All measures were self-report. Participating in DBT training was associated with positive changes over time, including improved therapist attitudes toward consumers with BPD, improved confidence in the effectiveness of DBT, and increased use of DBT components. Therapists who had the lowest baseline scores on the study outcomes had the greatest self-reported positive change in outcomes over time. Moreover, there were notable positive correlations in therapist characteristics; therapists who had the lowest baseline attitudes toward individuals with BPD, confidence in the effectiveness of DBT, or who were least likely to use DBT modes and components were the therapists who had the greatest reported increase over time in each respective area. DBT training with ongoing support resulted in changes not commonly observed in standard training approaches typically used in community settings. It is encouraging to observe positive outcomes in therapist self-reported skill, perceived self-efficacy and DBT component use, all of which are important to evidence-based treatment (EBT) implementation. Our results underscore the importance to recognize and target therapist diversity of learning levels, experience, and expertise in EBT implementation.

Evaluation of the observer effect on compliance training in adolescents with autism

Three mothers conducted behavioral observations of video clips of a mother conducting compliance training to varying degrees of accuracy. Subsequently, two mothers correctly conducted compliance training and their children emitted compliant behavior. Upon addition of feedback, the third mother correctly implemented compliance training and her child also emitted complaint behavior. Conducting behavioral observations may be a viable and efficient option for training parents to conduct compliance training and, if ineffective, can be supplemented by feedback.

The effects of behavioral skills training on instructor and learner behavior across responses and skill sets

Behavioral skills training (BST) is effective to train staff to provide intervention to people with developmental disabilities. The purpose of this study was to assess whether: (a) prior studies demonstrating the effectiveness of BST could be systematically replicated while teaching multiple teaching instructors to implement discrete trial teaching, incidental teaching and activity schedules; (b) instructional skills that staff acquired during training on one response generalized to a variety of instructional programs, (c) positive changes in staff performance produced positive behavior change in learners; and (d) positive changes in learner behavior generalized to novel programs. BST resulted in positive behavior change across staff, learners, instructional programs, and various teaching skills. Further, staff generalized teaching skills to novel responses and learners displayed increases in correct responding for all three instructional procedures. Social validity data indicated they these staff training procedures were highly acceptable and effective. Thus, BST is an effective and acceptable staff training procedure.

PEGASO: A Personalised and Motivational ICT System to Empower Adolescents Towards Healthy Lifestyles

Unhealthy alimentary behaviours and physical inactivity habits are key risk factors for major non communicable diseases. Several researches demonstrate that juvenile obesity can lead to serious medical conditions, pathologies and have important psycho-social consequences. PEGASO is a multidisciplinary project aimed at promoting healthy lifestyles among teenagers through assistive technology. The core of this project is represented by the ICT system, which allows providing tailored interventions to the users through their smartphones in order to motivate them. The novelty of this approach consists of developing a Virtual Individual Model (VIM) for user characterization, which is based on physical, functional and behavioural parameters opportunely selected by experts. These parameters are digitised and updated thanks to the user monitoring through smartphone; data mining algorithms are applied for the detection of activity and nutrition habits and this information is used to provide personalised feedback. The user interface will be developed using gamified approaches and integrating serious games to effectively promote health literacy and facilitate behaviour change.

Randomized trial of two e-learning programs for oral health students on secondary prevention of eating disorders

The purpose of this study was to test whether an interactive, web-based training program is more effective than an existing, flat-text, e-learning program at improving oral health students' knowledge, motivation, and self-efficacy to address signs of disordered eating behaviors with patients. Eighteen oral health classes of dental and dental hygiene students were randomized to either the Intervention (interactive program; n=259) or Alternative (existing program; n=58) conditions. Hierarchical linear modeling assessed for posttest differences between groups while controlling for baseline measures. Improvement among Intervention participants was superior to those who completed the Alternative program for three of the six outcomes: benefits/barriers, self-efficacy, and skills-based knowledge (effect sizes ranging from 0.43 to 0.87). This study thus suggests that interactive training programs may be better than flat-text e-learning programs for improving the skills-based knowledge and self-efficacy necessary for behavior change.

Disseminating an evidence-based course to teach self-management of auditory hallucinations

This multi-site project extended course dissemination of the 10-session Behavioral Management of Auditory Hallucinations Course to U.S. Department of Veterans Affairs (VA) mental health outpatient settings. The VA Quality Enhancement Research Initiative (QUERI) model and Rogers' theory of diffusion of innovations served as the theoretical framework. The course was taught to mental health professionals using teleconferencing, electronic media, and monthly conference calls across 24 VA mental health outpatient sites. Twenty course leaders provided feedback. One hundred percent reported being better able to communicate with patients about their voices and 96% reported improved understanding of the voice-hearing experience. Thirty-three course participants provided feedback. Ninety-four percent would recommend the course, 85% reported being better able to communicate with staff about their voices, and 66% reported being better able to manage their voices. Facilitators and barriers to course implementation are described.

A small-scale randomized controlled trial of the self-help version of the New Forest Parent Training Programme for children with ADHD symptoms

The efficacy of a self-help parent training programme for children with attention deficit hyperactivity disorder (ADHD) was evaluated. The New Forest Parenting Programme Self-help (NFPP-SH) is a 6-week written self-help psychological intervention designed to treat childhood ADHD. Forty-three children were randomised to either NFPP-SH intervention or a waiting list control group. Outcomes were child ADHD symptoms measured using questionnaires and direct observation, self-reported parental mental health, parenting competence, and the quality of parent-child interaction. Measures of child symptoms and parental outcomes were assessed before and after the intervention. ADHD symptoms were reduced, and parental competence was increased by self-help intervention. Forty-five percent of intervention children showed clinically significant reductions in ADHD symptoms. Self-help intervention did not lead to improvements in parental mental health or parent-child interaction. Findings provide support for the efficacy of self-help intervention for a clinical sample of children with ADHD symptoms. Self-help may provide a potentially cost-effective method of increasing access to evidence-based interventions for clinical populations.

Effects of conducting peer behavioral observations on the observer's correct use of discrete trial teaching procedures

A procedure consisting of peer observation and evaluation termed behavioral observations was used to improve educational staff's correct use of discrete trial teaching procedures (DTT). All participants had been previously trained and proficient in using DTT procedures; however, during baseline, showed a low level of correct demonstration of DTT procedures (mean scores: 38.3%, 43.3%, and 35.0%). Participants were then taught use a checklist to observe and score a peer's performance during DTT sessions in a classroom setting. After conducting behavioral observations, staff increased their correct usage of DTT procedures to 85.1%, 88.3%, and 81.1% respectively. These data indicate that conducting behavioral observations can lead to large and rapid improvements in educational staff's correct use of DTT procedures with a large effect size (d=4.19).

Developing an online, modular, active learning training program for behavioral activation

The current study reports on two sequential studies that developed and provided a pilot evaluation of a Behavioral Activation (BA) training package based on an online, modular, active learning model for community mental health providers. In the first study, training outcomes were assessed with a within-subjects design by measuring trainees' (N = 8) reported implementation of learned BA skills in clinical practice and their satisfaction with the training at pretraining baseline and throughout the training. The results showed that trainees reported increased implementation of BA techniques in actual sessions. Several improvements were made in the second study, including incorporating more active learning strategies to the training protocol and including a role-play Behavioral Activation Skills Assessment (BASA) for an objective rather than self-report measure of trainees' (N = 9) performance before, after, and 6 weeks after training. Results suggested that skill at implementing two of the three core BA techniques (providing the rationale and activity scheduling) increased significantly, and overall performance was maintained at follow-up. Furthermore, trainees reported high satisfaction with the training in both studies.

Behavioral kernels and brief interventions: teaching parents effective behavior management strategies

Reducing the high prevalence of emotional and behavioral problems among youth requires that parents be given access to high-quality, effective parenting supports and interventions. Recently developed brief parenting interventions can be delivered without stigma in primary health care and other settings by a range of professionals.

A meta-analysis of behavioral parent training for children with attention deficit hyperactivity disorder

This meta-analysis examined the effect of behavioral parent training on child and parental outcomes for children with attention deficit hyperactivity disorder. Meta-analytic procedures were used to estimate the effect of behavioral parent training on children with attention deficit hyperactivity disorder. Variables moderating the intervention effect were examined. Forty studies were included and generated an overall moderate effect size at post-treatment and a small effect size at follow-up. The majority of outcome categories were associated with a moderate effect size at post-treatment that decreased to a small effect size at follow-up. Parenting competence was the only outcome that had a large effect, which decreased to moderate at follow-up. The strength of the effect differed between questionnaire and observation measures. Behavioral parent training is an effective intervention for children with attention deficit hyperactivity disorder. Sustainability of the effects over time is a problem that awaits further scrutiny. Recommendations for further research and clinical practices are provided.

Developing behavioural training services to meet defined standards within an Australian statewide disability service system and the associated client outcomes

BACKGROUND

LaVigna, Christian, and Willis (2005) reported on a project where Institute for Applied Behaviour Analysis (IABA) staff trained a professional team in New Zealand (NZ) to provide behavioural services that met defined criteria. The NZ team was then trained to train other practitioners to meet the same professional standards. However, no client outcomes were reported in that study.

METHOD

This study replicates the NZ study within disability services in Tasmania, Australia. Further, this study examined the associated client outcomes and the impact of the training on severity ratings of subsequent referrals.

RESULTS

Tasmanian trainers trained participants to provide behavioural services that met the same professional standards. Client behavioural outcome data showed significant improvement. Referral data showed decreases in severity ratings.

CONCLUSIONS

The trainer of trainers process is effective in training staff to meet defined professional standards, including desired client outcomes, and to effectively make positive behaviour support accessible to a large number of people.

Commentary: adding realism and perspective to behavioral counseling curricula for medical students

Hauer and colleagues have made an important contribution to medical education by documenting how best to teach behavioral counseling skills to medical students. Although the authors of this commentary agree that these skills are important for physicians to learn, they argue that physicians must acknowledge realities regarding the role of physicians as behavioral counselors and the limited effectiveness of counseling during clinical encounters. Students and physicians need to understand the limited role that the medical care system plays in determining lifestyles and the more potent effect that community-wide interventions can have. The authors call for education about behavioral counseling that teaches necessary skills, yet develops realistic expectations of what physicians can and cannot do by themselves, understanding of when to refer patients for intensive counseling, and recognition of the importance of societal factors in effecting behavior change.

Behavior change counseling curricula for medical trainees: a systematic review

PURPOSE

Unhealthy behaviors contribute to half of U.S. deaths. However, physicians lack sufficient skill in counseling patients to change behaviors. Characterizing effective published curricular interventions for behavior change counseling for medical trainees would inform educators toward improved training.

METHOD

The authors conducted a systematic literature search of studies published between 1965 and 2011 evaluating curricula on behavior change counseling for medical trainees. Included studies described behavior change counseling, teaching interventions for medical trainees, and assessment of interventions. The authors extracted eligible articles, rated outcomes for learners and patients using Kirkpatrick's hierarchy, and determined study quality.

RESULTS

Of 2,788 identified citations, 109 met inclusion criteria. Most studies were performed in the United States (98), 93 at a single institution, and 81 in primary care settings. Curricular topics for counseling included smoking (67 studies), nutrition (30), alcohol/drug use (26), and exercise (22). Although most studies did not include theoretical frameworks, 39 used the Transtheoretical Model of Change. Sixty-two studies involved eight or fewer hours of curricular time, and 51 spanned four or fewer weeks. The studies with highest-level outcomes and quality employed multiple curricular techniques and included practice of counseling techniques in either simulated or actual clinical settings.

CONCLUSIONS

Existing literature suggests that trainees learn behavior change counseling through active, realistic practice and implementation of reminder and feedback systems within actual clinical practice settings. Multiinstitutional medical education research on methods of teaching behavior change counseling that influence patients' health outcomes are needed to ensure trainees' clinical competence and improve patient care.