THE EFFECT OF INFORMATIONAL FEEDBACK ON FOOD INTAKE OF ADULT BURN PATIENTS

The effect of informational feedback on the protein and caloric consumption of burn patients was investigated using a multiple-baseline across subjects. The patients were four severely burned adult males who failed to consume sufficient foods to achieve prescribed levels of protein or kilocalories via standard burn unit procedures during recovery. Feedback consisted of informing patients of (a) their prescribed levels of protein and kilocalories, (b) the protein and kilocalorie content of hospital foods and beverages, and (c) their actual intake of protein and kilocalories. Following the provision of feedback, there was an increase in protein and kilocalorie intakes and in the number of days during which prescribed levels for protein and kilocalories were achieved. These results suggest that the informational feedback was effective for improving the oral caloric intake of burn patients.     

INCREASING THE IMMUNIZATION OF PRESCHOOL CHILDREN; AN EVALUATION OF APPLIED COMMUNITY INTERVENTIONS

We evaluated the relative impact of four procedures designed to encourage parents to obtain immunizations for their children. In a public health setting, the families of 1,133 immunization-deficient preschool children were randomly assigned to six conditions: (a) a general prompt; (b) a more client-specific prompt; (c) a specific prompt and increased public health clinic access; (d) a specific prompt and monetary incentives; (e) contact control; and (f) no contact control. All interventions, except the general prompt, produced some evidence of improvement when compared with the control groups. The monetary incentive group revealed the largest effect, followed by the increased access group, specific prompt group, and general prompt group, respectively. The data suggest that relatively powerful and immediate effects on preschoolers' clinic attendance for immunization may be produced by monetary incentives in conjunction with client-specific prompts. However, client-specific prompts alone appear to be the most cost-effective of the interventions.     

ACQUISITION AND MAINTENANCE OF HEALTH-CARE ROUTINES AS A FUNCTION OF FEEDBACK DENSITY

Two schedules of feedback were examined to determine their relative effects on the acquisition and maintenance of three health-care routines: feeding, positioning, and transferring physically disabled patients. Four direct service providers' performances in the natural environment were measured weekly. Concurrent schedules and multiple baselines across subjects and response classes were used to evaluate the effects of written instructions combined with either continuous, intermittent, or no-feedback schedules. Results showed that instructions alone led to slight and usually brief changes. Marked improvements were noted after feedback was introduced, with the continuous schedule producing more rapid acquisition. Follow-up measures indicated performance maintenance for both schedules. Subjects rated the feedback programs favorably and recommended provision of this service to co-workers. Cost estimates indicated that, although considerable time was spent developing the observational system, the feedback procedure was relatively inexpensive, easy to use, and did not interfere with patient care.     

THE COSTS OF EATING: A BEHAVIORAL ECONOMIC ANALYSIS OF FOOD REFUSAL

Behavioral economic concepts were applied to the analysis and treatment of pediatric feeding disorders in a clinical setting. In Experiment 1, children who chronically refused food were presented with varying amounts of food on a spoon (empty, dipped, quarter, half, and level). Each child exhibited a different but orderly demand function of response (acceptance, expulsion, and mouth clean) by cost (increasing spoon volume) for a constant pay-off of toys and social interaction. In Experiment 2, physical guidance or nonremoval of the spoon for food refusal was initiated at the smallest spoon volume with low levels of acceptance, and was subsequently introduced at the largest spoon volume with moderate levels of acceptance. Treatment was effective in increasing acceptance, and these effects generalized hierarchically across untargeted spoon volumes. The results of both studies provide preliminary support that increasing spoon volume can be equated conceptually with increasing response effort, and that the change from differential reinforcement to physical guidance or nonremoval of the spoon appears to have altered the elasticity of each child's demand function.     

A PRELIMINARY EVALUATION OF EMPIRICALLY DERIVED CONSEQUENCES FOR THE TREATMENT OF PICA

Individualized treatment packages were developed for 3 children with high-rate severe pica using a discrimination training paradigm and a behavioral assessment-based procedure known as empirically derived consequences. Children received empirically derived reinforcers for eating under appropriate stimulus conditions (i.e., eating food only from a plate and placemat that served as a discriminative stimulus) and empirically derived punishers for attempts to engage in pica. This treatment package resulted in marked reductions in pica and an increase in appropriate eating for all 3 children in a “baited” analogue condition. In addition, low rates of pica were maintained for 9 months for all 3 children. These results suggest that treatment effectiveness may be enhanced when behavioral assessment data are used to identify potent consequences.     

EVALUATION OF A TRAINING MANUAL FOR THE ACQUISITION OF BEHAVIORAL ASSESSMENT INTERVIEWING SKILLS

Two procedures were used to teach behavioral assessment interviewing skills: a training manual and one-to-one instruction that included modeling, rehearsal, and feedback. Two graduate students and two advanced undergraduates were trained with each procedure. Interviewing skills were recorded in simulated assessment interviews conducted by each student across baseline and treatment conditions. Each training procedure was evaluated in a multiple baseline across students design. The results showed that both procedures were effective for training behavioral interviewing skills, with all students reaching a level of 90%-100% correct responding. Finally, a group of experts in behavior analysis rated each interviewing skill as relevant to the conduct of an assessment interview and a group of behavioral clinicians socially validated the outcomes of the two procedures.     

BIOFEEDBACK AND RATIONAL-EMOTIVE THERAPY IN THE MANAGEMENT OF MIGRAINE HEADACHE

Twenty-four migraine patients were randomly assigned to one of four conditions: (a) self-monitoring of headache activity (waiting list), (b) frontalis EMG biofeedback, (c) digit temperature biofeedback, and (d) digit temperature biofeedback plus Rational-Emotive Therapy (RET). Bidirectional control over the target physiological response was assessed through a reversal design in each session. Following at least a four-week baseline, the three biofeedback groups received 8 to 10, 30-minute sessions of bidirectional biofeedback training, scheduled twice a week. Subjects in the combined digit temperature biofeedback plus RET group received three 40-minute sessions of RET as an addition to the third, fifth, and seventh biofeedback sessions. Records of daily home practice were kept throughout treatment and three-month followup. Subjects on the waiting list monitored headaches for at least five months, corresponding to “baseline”, “treatment”, and three-month followup. Digit temperature biofeedback alone and in conjunction with RET did not prove to be more effective than the control conditions. All the EMG subjects reduced headache activity to two-thirds or less of the baseline level by the third month of followup. Bidirectional digit temperature performance did not improve with training, was demonstrated in only 33% of the biofeedback sessions, was not maintained over time, and was unrelated to improvement in headache activity. EMG subjects reported biofeedback performance to be an easier task and met the performance criterion on 85% of the sessions. The frequency of home practice contributed over 55% of the variance in retrospective estimates of headache improvement but was not related to changes in daily records of headache activity.     

THE EFFECTS OF SELF-MONITORING AND SUPERVISOR FEEDBACK ON STAFF PERFORMANCE IN A RESIDENTIAL SETTING

We evaluated the effects of a self-monitoring procedure to increase staff on-task behavior and adherence to scheduled activities. Self-monitoring involved the use of activity cards that staff members completed and carried with them to assist in determining the activities for which they were responsible at any given time. Increases in both on-schedule and on-task behavior resulted. Supervisor feedback was subsequently added because some staff members did not maintain consistently high levels of performance. Generalization data indicated that staff members implemented the procedure during evening hours without specific programming. The advantages and limitations of using a self-monitoring procedure for improving performance of staff members in residential settings are discussed.     

VISITING THE DENTIST: A BEHAVIORAL COMMUNITY ANALYSIS OF PARTICIPATION IN A DENTAL HEALTH SCREENING AND REFERRAL PROGRAM

One-hundred and twenty-five families in the Medicaid Early Periodic Screening, Diagnosis and Treatment Program were assigned to one of five treatments to encourage parents to obtain health care service following the dental screening of their children: (a) a control procedure, in which parents were given a dentist's name; (b) a multiple contact procedure, in which parents received a postcard and two telephone call reminders; (c) a problem-solve procedure, in which a social worker aide conducted a brief session with the parent; (d) an incentive procedure, in which parents selected among four gifts that were contingent on seeking care; (e) an incentive + problem-solve procedure, in which the latter two treatments were combined. The multiple contact, incentive, and incentive + problem-solve techniques were significantly more effective in initiating dental visits than the control procedures. Families assigned to the intensive strategies were most likely to complete treatment. A cost-efficiency analysis showed the multiple contact technique to be a low-cost and highly effective procedure.     

EFFECTS OF A VIDEOTAPE FEEDBACK PACKAGE ON THE PEER INTERACTIONS OF CHILDREN WITH SERIOUS BEHAVIORAL AND EMOTIONAL CHALLENGES

Peer interactions are among the greatest challenges experienced by children who have severe emotional and behavioral problems. This study evaluated an intervention package designed to increase the ratio of these children's desirable to undesirable interactions. The package included three principal components: (a) observation of videotapes following regularly scheduled peer activity sessions; (b) self-evaluation of the children's peer interactions observed on the videotapes; and (c) delayed feedback and reinforcement for desirable peer interactions. Five students from two elementary schools participated. Multiple baseline designs and one reversal were used to evaluate the effects of the intervention package. The results showed that the intervention produced lower levels of undesirable peer interactions and higher ratios of desirable to undesirable interactions for all participants. The results are discussed in regard to their conceptual and applied implications and in terms of specific directions for future research.     

TEACHING PERSONS WITH PROFOUND MULTIPLE HANDICAPS: A REVIEW OF THE EFFECTS OF BEHAVIORAL RESEARCH

The behavioral research on teaching individuals who have profound multiple handicaps is reviewed. The primary focus is on determining the degree to which behavioral research has demonstrated the teaching of meaningful skills to this population. Results of the review indicate that investigations have demonstrated, albeit inconsistently, that behavior change has resulted from contingency management interventions with persons who have profound multiple handicaps. However, there is little evidence that such interventions have resulted in meaningful behavior change according to currently accepted criteria for beneficially affecting the quality of life of persons with serious handicaps. Potential explanations for the lack of such evidence are offered, including the relative lack of research attention given to this issue, the possible ineffectiveness of the components of the technology applied, and possible ineffective application of the potentially effective technology. Suggestions for future research are discussed in terms of developing more effective educational and habilitative services for persons with profound multiple handicaps. In particular, we suggest research on a wider variety of behavioral teaching procedures, providing more comprehensive evaluations of the applications of procedures and developing treatment programs that do not focus solely on traditional skill acquisition.     

THE GOOD TOOTHBRUSHING GAME: A SCHOOL-BASED DENTAL HYGIENE PROGRAM FOR INCREASING THE TOOTHBRUSHING EFFECTIVENESS OF CHILDREN

There has been a serious lack of experimentally verified, effective dental hygiene programs in the schools. In and of themselves, the instruction-alone programs which comprise children's dental education do not produce proper toothbrushing skills. In the present study, a school-based contingency dental hygiene program designed to increase the effectiveness of children's toothbrushing skills at home was implemented with grade one and two classes. Each class was divided into teams and participated in the “Good Toothbrushing Game.” Each day four children from each team had the cleanliness of their teeth assessed according to the Simplified Oral Hygiene Index (Greene & Vermillion, 1964). The team with the lowest mean oral hygiene score was declared the daily winner. Winning teams received stickers and had their names posted. A multiple baseline across classrooms single-subject group design (Hersen & Barlow, 1976, pp. 228–229) established that the good toothbrushing game greatly increased the effectiveness of children's oral hygiene skills. The treatment terminal level for the grade one scores was 2.0 as compared to a baseline terminal level of 5.0, and for the grade two's was 2.3 compared to 5.7 at the end of baseline. A 9-mo follow-up indicated that these results were maintained. The data strongly suggest that proper implementation of behavioral principles is essential to the success of oral hygiene programs.     

BIOFEEDBACK,AUTOGENIC TRAINING,AND PROGRESSIVE RELAXATION IN THE TREATMENT OF RAYNAUD'S DISEASE: A COMPARATIVE STUDY

Twenty-one female patients suffering from diagnosed idiopathic Raynaud's Disease were trained to raise digital skin temperature using either autogenic training, progressive muscle relaxation, or a combination of autogenic training and skin temperature feedback. Patients were instructed in the treatment procedures in three one-hour group sessions spaced one week apart. All patients were instructed to practice what they had learned twice a day at home. Patients kept records of the frequency of vasospastic attacks occurring over a four-week baseline period, and during the first four weeks and the ninth week of training. In addition, patients underwent four laboratory cold stress tests during which they were instructed to maintain digital temperature as the ambient temperature was slowly dropped from 26° to 17°C. Cold stress tests were given during week 1 of baseline and during weeks 1, 3, and 5 of training. Results indicated that all patients improved during the first four weeks of training. No significant differences between the three behavioral treatment procedures were obtained. In addition, the ability of patients to maintain digital temperature during the cold stress challenge showed significant improvement from the first to the last tests. Symptomatic improvement was maintained by all patients nine weeks after the start of the training. The implications of these findings for the behavioral treatment of Raynaud's Disease are discussed.