Preparing direct service staff to teach people with severe disabilities: A comprehensive evalution of an effective and acceptable training program

In light of the continuing need for residential, direct service staff to be able to teach people with severe disabilities, we comprehensively evaluated a program to train staff in behavioral teaching strategies. The program was developed and evaluated with attention given to recent concerns in the staff management literature regarding shortcomings with staff training research. The training program, involving a maximum of four, 2-hr classroom instruction sessions and three in vivo observation and feedback sessions, was evaluated in four studies. In Study 1, the program was shown to improve verbal skills of 13 direct service staff regarding behavioral teaching principles and terminology. In Study 2, the program was demonstrated to improve performance based teaching skills of nine staff and four staff supervisors. In Study 3, the program was shown to result in improvements in adaptive skills of three clients with severe disabilities when direct care staff used their newly acquired teaching skills with the clients. In Study 4, the training program was shown to be well received among 17 staff trainees, although the trainees were more accepting of some program components than others. Results of the studies are discussed in regard to the importance of agencies providing effective and acceptable staff training programs. Future research areas also are noted, focusing on the need to determine, and minimize where possible, the amount of time required to conduct successful staff training.     

INCREASING INDEPENDENCE AMONG CHILDREN DIAGNOSED WITH AUTISM USING A BRIEF EMBEDDED TEACHING STRATEGY

The purpose of this study was to evaluate the effects of a brief embedded teaching procedure, involving least‐to‐most prompting for two paraprofessional staff in order to increase independent responses of two children diagnosed with autism in an inclusive setting. Training was given using a behavioral skills training approach, involving instructions, modeling, rehearsal, and feedback. A multiple‐baseline design across behaviors was used to evaluate the effects of the embedded teaching procedure. Maintenance of training effects was evaluated two weeks, following the end of the study. After training of the brief embedded prompting procedure and during following up probes, both students showed increased independence in each skill that staff were trained to teach. Copyright © 2012 John Wiley & Sons, Ltd.     

TRAINING RESIDENTIAL SUPERVISORS TO PROVIDE FEEDBACK FOR MAINTAINING STAFF TEACHING SKILLS WITH PEOPLE WHO HAVE SEVERE DISABILITIES

We evaluated procedures for training supervisors in a residential setting to provide feedback for maintaining direct-service staff members' teaching skills with people who have severe disabilities. Using classroom-based instruction and on-the-job observation and feedback, 10 supervisors were initially trained to implement teaching programs themselves. The training improved supervisors' teaching skills but was insufficient to improve the quality of feedback they provided to direct-service staff regarding the staff members' teaching skills. Subsequently, classroom-based instruction and on-the-job observation and feedback that targeted supervisors' feedback skills were provided. Following training in provision of feedback, all supervisors met criterion for providing feedback to their staff. Results also indicated that maintenance of teaching skills was greater for direct-service staff whose supervisors had received training in providing feedback relative to staff whose supervisors had not received such training. The need for analysis of other variables that affect maintenance of staff performance, as well as variables that affect other important areas of supervisor performance, is discussed.     

Interactive computer training to teach discrete‐trial instruction to undergraduates and special educators in Brazil: A replication and extension

Discrete‐trial instruction (DTI) is a behavioral method of teaching young children with autism spectrum disorders (ASD) that has received a significant amount of research support. Because of a lack of qualified trainers in many areas of the world, researchers have recently begun to investigate alternative methods of training professionals to implement behavioral teaching procedures. One promising training method is interactive computer training, in which slides with recorded narration, video modeling, and embedded evaluation of content knowledge are used to teach a skill. In the present study, the effectiveness of interactive computer training developed by Pollard, Higbee, Akers, and Brodhead (2014), translated into Brazilian Portuguese, was evaluated with 4 university students (Study 1) and 4 special education teachers (Study 2). We evaluated the effectiveness of training on DTI skills during role‐plays with research assistants (Study 1) and during DTI sessions with young children with ASD (Studies 1 and 2) using a multiple baseline design. All participants acquired DTI skills after interactive computer training, although 5 of 8 participants required some form of feedback to reach proficiency. Responding generalized to untaught teaching programs for all participants. We evaluated maintenance with the teachers in Study 2, and DTI skills were maintained with 3 of 4 participants.     

Using the teaching interaction procedure to train interventionists to implement the Cool versus Not CoolTM procedure

The teaching interaction procedure is a behavior analytic procedure that has been used to target the development of social skills. The teaching interaction procedure consists of labeling the target skill, providing a meaningful rationale, describing the steps of the target skill, modeling the skill, role‐play, and providing feedback throughout the interaction. Although the teaching interaction procedure has been used to teach a variety of social skills for individuals diagnosed with autism spectrum disorder (ASD), it has only been used to train staff in two studies. The purpose of this study was to evaluate the use of the teaching interaction procedure to teach three interventionists to implement the Cool versus Not Cool? procedure to target the development of social skills for children diagnosed with ASD. The results of a multiple baseline design demonstrated that the teaching interaction procedure was effective for all three interventionists. Results of the child participants' skill acquisition are also provided.     

Validation of the Peer Social Maturity Scale for Assessing Children's Social Skills

We evaluated the utility of a brief, seven‐item, teacher‐rated Peer Social Maturity Scale (PSMAT). In Study 1, teachers of 138 Australian children (ranging from 5 to 8 years and 5 months old) in kindergarten and Grades 1 and 2 rated their pupils' social maturity using the PSMAT and their classroom social skills via the Social Skills Rating System (SSRS). The PSMAT showed excellent internal consistency and a significant overall correlation with the SSRS social skills scale. Study 2 involved a new longitudinal sample of children who were rated by different classroom teachers in kindergarten and Grades 1 and 2 of full‐time primary school. Consistent with Study 1, at all three time points, PSMAT scores were highly correlated with SSRS social skills scores. PSMAT scores also correlated significantly with peer‐rated social preference. These studies confirm that the PSMAT is a reliable and valid assessment of children's social maturity within their classroom peer groups. Copyright © 2013 John Wiley & Sons, Ltd.     

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.     

Assessing and teaching job‐related social skills to adults with autism spectrum disorder

Few studies have evaluated interventions to improve the job‐related social skills of adults with autism spectrum disorder. In this study, we examined the efficacy of a treatment package for teaching several social skills that are critical to job success, such as responding appropriately to feedback and asking for a task model from the supervisor. Three adults, aged 19 to 27 years, participated. Initial training of each skill consisted of verbal explanations, modeling, and role‐play with feedback, along with stimulus prompts to promote generalization to a different setting. The trainer introduced additional intervention components as needed. We also evaluated generalization across different social skills and evocative situations. Results indicated that the treatment package was generally effective in improving the targeted social skills, and that stimulus prompts may be necessary for generalization to a job setting. However, generalized responding across social skills rarely emerged. These findings have important implications for preparing individuals with autism to function successfully on the job.     

INVOLVING INSTITUTIONAL STAFF IN THE DEVELOPMENT AND MAINTENANCE OF SIGN LANGUAGE SKILLS WITH PROFOUNDLY RETARDED PERSONS

A program to involve institutional staff in developing manual sign language skills with profoundly retarded persons was evaluated. In Experiment 1, six direct care staff, with close supervision, taught a small repertoire of signs to six profoundly retarded residents who had not benefited from previous training in vocal language. Training was conducted in a group format using instructions, modeling, manual guidance, contingent reinforcers, and feedback. During training, all residents learned to identify pictures of objects with manual signs. Generalization observations during unstructured times on the residents' living unit indicated that staff used their signing skills with the residents in addition to their vocal interactions but the residents did not increase their signing or vocalizing. In Experiment 2, the residents' skills in signing with real objects on their living unit as opposed to pictures of objects were evaluated and provided with additional training where necessary. Results indicated that all participating residents learned to communicate with signing during structured interactions on their living unit, and the skills maintained during follow-up assessments ranging from 39 to 49 weeks. Results are discussed regarding the variable generalization effects noted as well as the general benefits and disadvantages of teaching manual signing skills to profoundly retarded persons.     

VIDEO MODELING TO TRAIN STAFF TO IMPLEMENT DISCRETE‐TRIAL INSTRUCTION

Three new direct‐service staff participated in a program that used a video model to train target skills needed to conduct a discrete‐trial session. Percentage accuracy in completing a discrete‐trial teaching session was evaluated using a multiple baseline design across participants. During baseline, performances ranged from a mean of 12% to 63% accuracy. During video modeling, there was an immediate increase in accuracy to a mean of 98%, 85%, and 94% for each participant. Performance during maintenance and generalization probes remained at high levels. Results suggest that video modeling can be an effective technique to train staff to conduct discrete‐trial sessions.     

AN INSTITUTIONAL STAFF TRAINING AND SELF-MANAGEMENT PROGRAM FOR DEVELOPING MULTIPLE SELF-CARE SKILLS IN SEVERELY/PROFOUNDLY RETARDED INDIVIDUALS

Although considerable attention has been given to the development of institutional staff training and management programs, the generalized effects of such programs on staff and resident behavior have seldom been examined. This study evaluated a program for teaching institutional staff behavioral training and self-management skills during self-care teaching sessions with severely and profoundly retarded residents. Following baseline observations in three self-care situations (toothbrushing, haircombing, handwashing), four direct care staff were sequentially taught to use verbal instruction, physical guidance, and contingent reinforcement in the toothbrushing program. During maintenance, staff were simultaneously taught to record, graph, and evaluate resident and their own behavior in the toothbrushing sessions. Staff were taught use of the training and self-management skills through a sequence of written instructions, videotaped and live modeling, rehearsal, and videotaped feedback. Observer presence and experimenter supervision were gradually decreased during the maintenance condition. Results indicated that during training and maintenance staff: (a) learned to use the training skills appropriately and consistently in the example situation (toothbrushing); (b) applied the skills in the generalization situations (haircombing and handwashing); and thereafter (c) maintained consistent and appropriate use of the skills with infrequent supervision. In addition, important changes in retarded residents' independent self-care responding occurred as staff training skills developed. Results are discussed in terms of their implication for future research and continued development of effective staff training and management programs.     

THE EFFECTS OF BEHAVIOR SKILLS TRAINING ON CORRECT TEACHER IMPLEMENTATION OF NATURAL LANGUAGE PARADIGM TEACHING SKILLS AND CHILD BEHAVIOR

Natural Language Paradigm (NLP) is a naturalistic teaching strategy for children with autism that increases immediate and delayed imitative utterances, spontaneous utterances and new words, and production of utterances. NLP includes increasing child choice, varying stimulus items, loose shaping contingencies for communicative attempts, and providing reinforcers with a direct relationship to the response. Only one previous study investigated the effects of behavioral skills training (BST) on staff acquisition and generalization of implementation of NLP and child behavior. A BST package of instructions, modeling rehearsal and feedback, was used to train teachers to implement NLP teaching procedures with three pre‐school children with autism spectrum disorder. Training increased correct teacher performance systematically across all three teachers during NLP teaching sessions and with children for whom teachers did not directly receive training. Correct teacher performance increased appropriate child vocalizations and decreased maladaptive behavior for four of six children. BST is effective in quickly training teachers in the generalized implementation of complex NLP teaching procedures across children. Copyright © 2012 John Wiley & Sons, Ltd.     

COMPARISON OF STAFF TRAINING STRATEGIES TO PROMOTE GENERALIZED TEACHING SKILLS

Two studies compared the effectiveness of different strategies for promoting generalization of staff skills in teaching self-care routines to clients with developmental disabilities. In Study 1, 9 direct-care staff members of group homes were trained sequentially through four conditions: (a) the provision of written instructions, (b) performance-based training using a single client program exemplar and simulated clients (single case training), (c) performance-based training using actual developmentally delayed clients as trainees (common stimuli training), and (d) performance-based training using multiple client program exemplars with simulated clients (general case training). The results indicated that staff members did not reach all generalization criteria until general case training was provided. Because staff members had been trained sequentially through several conditions in Study 1, a second study controlled for potential sequence effects. In Study 2, 7 staff members were trained using only the general case strategy after baseline. All staff members reached generalization criteria with only general case training, replicating the findings of Study 1. Together, the two studies demonstrated that the general case training strategy was more effective at promoting generalized training effects across clients, settings, and client programs than other commonly used staff training approaches.     

Teaching college students to pour accurately using behavioral skills training: Evaluation of the effects of peer modeling

Excessive alcohol consumption among college students is a serious problem. Alcohol education courses, during which students are taught to free‐pour accurate servings of alcohol, have been proposed as one strategy to reduce this problem. However, few studies have evaluated the effects of peer models on free‐pour skill maintenance. We used a nonconcurrent multiple‐baseline across subjects design to assess the effects of peer modeling on maintenance of college students' (N = 19) pouring skills of a standard serving of beer immediately following Behavioral Skills Training (BST). Results indicated participants who inaccurately poured a standard serving of beer at baseline (n = 17) accurately poured following receipt of BST, and all participants (N = 19) maintained accurate pouring in the presence of peer confederate models who poured inaccurately or accurately. Results suggest BST is an efficient (i.e., low to no‐cost, requires no sophisticated laboratory space or software, and makes use of available and affordable materials) and effective tool for teaching college students to pour standard servings of beer and that the immediate introduction of inaccurately pouring peer models has little or no effect on skill maintenance.     

Reciprocal peer management: Improving staff instruction in a vocational training program

To test the feasibility and utility of involving peers as sources of feedback, 6 subjects, instructors in a vocational program for adults with mental retardation, participated in a staff training and management program. Subjects' teaching interactions were assessed during baseline, in-service training (on effective teaching), return-to-baseline, peer management, and follow-up phases. Peer management was introduced in multiple baseline fashion across pairs of subjects. Members of each pair were trained to monitor peer teaching, to record and graph data, to provide feedback, and to set goals with the peer. Each pair then performed these procedures on the job for several weeks, during which time 4 of the 6 subjects increased their use of effective teaching methods (over baseline). However, inconsistencies in the magnitude and durability of these increases require that the study be viewed as inconclusive, although it has heuristic value as a promising model for involving co-workers in staff management programs.     

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 consequences) 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.     

Case manager: A clinical tool for training residential treatment staff

Various behavioral approaches to institution staff training have appeared in the literature, with some showing that traditional didactic-type instruction or tangible extrinsic reinforcement is not always necessary for effective training. The system described here used principles of modeling and feedback to teach institution staff behavior management skills. In addition, staff were assigned special titles, i.e., “case manager.” Results indicate that this individualized system was associated with improvements in the target behaviors in question, and also increased the amount of time staff properly interacted with assigned residents. Implications are with regard to using this efficient approach as a clinical tool for training staff to be effective behavioral technicians.