An evaluation of a caregiver training protocol on the generalization and maintenance of successful pediatric feeding interventions

Previous researchers have documented the positive effects achieved by trained clinicians providing behavioral interventions for pediatric feeding disorders; however, few have evaluated the maintenance of those treatments when subsequently implemented by primary caregivers. Further, the majority of previous caregiver training research has relied on the use of multicomponent training packages making it difficult to determine which components are necessary for success. The purpose of the current investigation was to evaluate the effects of instructions and feedback on caregivers' implementation of feeding protocols in a home setting. Results of the current study suggest that feedback may be the most effective training component in training packages designed to teach caregivers to implement an effective feeding protocol. Potential concomitant changes in child behavior are also discussed.     

Training parents to implement pediatric feeding protocols

Four different multicomponent training packages were evaluated to increase the treatment integrity of parents implementing pediatric feeding protocols. In Study 1 we exposed 3 parents to a training package that consisted of written protocols (baseline), verbal instructions, therapist modeling, and rehearsal training. Results suggested that the package was successful in increasing treatment integrity of the feeding protocols to high levels. Study 2 investigated three different parent-training packages comprised of components used in Study 1. Two parents were exposed to written protocols, verbal instructions, and modeling; 2 parents were exposed to written protocols, verbal instructions, and rehearsal; and 2 parents were exposed to written protocols and verbal instructions. Results of Study 2 showed that each parent-training package produced very high treatment integrity. Follow-up data in the clinic and home for 5 participants suggested that the results were durable for up to 3 months. These results demonstrate a first step in the transfer and application of research findings into routine clinical practice because we evaluated several methods for training parents to implement behavioral feeding protocols, and we demonstrated that these methods resulted in high levels of treatment integrity in a controlled clinical setting.     

Pyramidal training for families of children with problem behavior

The pyramidal training model was extended to multiple family members of children with behavior disorders. Three primary caregivers were taught to implement individualized treatments for problem behavior. They were then taught how to use various instructional strategies (e.g., prompting, feedback) to teach 2 other family members to implement the treatment. Results showed that pyramidal training was effective in increasing caregiver implementation of treatments across three families.     

SEQUENTIAL APPLICATION OF CAREGIVER TRAINING TO IMPLEMENT PEDIATRIC FEEDING PROTOCOLS

The purpose of this study was to evaluate the effectiveness of current caregiver training practices by implementing training components sequentially, to teach parents mealtime protocols. A multiple baseline design was implemented across two caregiver dyads. Therapist‐fed meals were conducted prior to training to identify an effective intervention to increase food acceptance and decrease food refusal. The package consisted of seven components: observation, written and verbal protocol review, video review, structured observation, modeling, role play, and immediate feedback. Correct implementation of mealtime protocols, by caregivers, were evaluated throughout the training process by having caregivers conduct meal sessions following each training component to determine if additional training was necessary. Results showed that the training procedures were effective in teaching caregivers to implement mealtime protocols, and systematic introduction of the training components produced systematic and incremental changes in correct caregiver implementation. In addition, all participants completed training without requiring all seven training components. Copyright © 2012 John Wiley & Sons, Ltd.     

Evaluation of a self-instruction package for conducting stimulus preference assessments

Research suggests that inexperienced individuals cannot accurately implement stimulus preference assessments given written instructions alone. Training that includes written instructions supplemented with feedback from a professional with expertise in conducting preference assessments has proven effective; unfortunately, expert-facilitated direct training may not be widely available. In the current study, we used multiple baseline designs to evaluate the efficacy of an antecedent-only self-instructional package to train staff members to implement two methods of stimulus preference assessments. Accuracy was low when participants had access to written instructions alone. When access to enhanced written instructions was provided (i.e., technical jargon was minimized; instructions included pictures, diagrams, and step-by-step examples), inexperienced staff accurately implemented the assessments. Results are discussed in terms of opportunities to disseminate behavior-analytic technologies through self-instruction and print resources.     

The effects of behavioral skills training on staff implementation of discrete-trial teaching

A behavioral skills training package was used to train 3 teachers to correctly implement discrete-trial teaching. The mean baseline proportion of possible correct teaching responses for Teachers 1, 2, and 3 increased from 43%, 49%, and 43%, respectively, during baseline to 97%, 98%, and 99%, respectively, following training. These data indicate that the training package consisting of instructions, feedback, rehearsal, and modeling produced rapid and large improvements in the teachers' implementation of discrete-trial teaching.     

Further evaluation of modified‐bolus‐placement methods during initial treatment of pediatric feeding disorders

Children with feeding disorders might pack or expel food when they lack the oral‐motor skills, the motivation, or both, to swallow. Bolus placement directly on the tongue with a Nuk (e.g., Milnes et al., 2019) or flipped spoon (e.g., Sharp et al., 2010) is a treatment that researchers generally implement after such behavior emerges (e.g., Girolami et al., 2007). However, Wilkins et al. (2014) tested the relative efficacy of Nuk presentation and upright‐spoon presentation during initial treatment of pediatric feeding disorders. In the current study, we compared the effects of (a) upright‐spoon presentation; (b) Nuk presentation; and (c) flipped‐spoon presentation on two product measures of swallowing: 15‐ and 30‐s mouth clean, and expulsion during the initial treatment of feeding disorders with 5 children. We also monitored lip closure during bite presentation and following bolus placement. Nuk presentation produced the highest levels of mouth clean and the lowest rates of expels relative to upright‐spoon presentation and flipped‐spoon presentation. We discuss potential reasons why modified‐bolus‐placement methods improved feeding behavior and how measures of oral‐motor skills might predict its necessity during initial treatment.     

A component analysis of job interview training for young adults with autism spectrum disorder

The job interview is a vital component to acquire employment. Individuals with autism spectrum disorder may experience difficulties with job interviews due to notable deficits in social and communication skills. We evaluated the relative impact of several components of a job interview training package on six participants' responses to commonly asked interview questions. We used a multiple baseline design across participants to present the following components: written instructions, rehearsal and video self‐feedback with a commercially available training program, and verbal feedback delivered by the experimenter. Results demonstrated that all participants required an additional behavioral skills training session to meet our mastery criterion. However, once training was complete, all participants showed generalized performance when the interview questions were presented in a varied format and by a novel interviewer outside of the training environment. In addition, their performance was maintained at follow‐up.     

Teaching caregivers to respond safely during agitated states before aggression using simulation training

Individuals who engage in aggression often display precursors or agitated behavior first, and it is important for caregivers to learn how to minimize risk of injury in the event that aggression were to occur. In this study, behavioral skills training was used to teach 4 caregivers of children who engage in aggression to position their body safely and prevent access to dangerous items during agitated states. Confederates were used during all baseline, training, and posttraining sessions to maintain consistency and the safety of the caregivers. All caregivers quickly learned to use these safety skills during agitated periods but not during calm periods with minimal between-session feedback regarding correct responding.     

Using Behavioral Skills Training to Teach Interview Skills to Young Adults with Autism

With unemployment rates for adults with autism as high as 85%, it is important for young adults to learn necessary prevocational skills (e.g., interviewing) to help them succeed in their search for employment. There is little research showing that individuals with autism can be taught to respond appropriately during an interview to secure future employment opportunities. We replicated the results of Stocco et al. (J Appl Behav Anal 50:495–510, 2017. https://doi.org/10.1002/jaba.385) who evaluated the effects of behavioral skills training on the interview skills of college students. We used a multiple baseline design across three responses (i.e., asking questions, answering questions and appropriate body language) to extend these results to three young adults with autism. During baseline, responding was low across all three responses for all three participants. Behavioral skills training consisted of role-playing simulated interviews, providing feedback and performance rehearsals. For two of the participants, behavioral skills training alone was effective at increasing all three responses. For the third participant, we added textual cues and reinforcement during behavioral skills training to reach criterion performance. Results demonstrated that adults with autism can benefit from modified behavioral skills training to improve interview skills and employment opportunities. Social validity of responses was assessed by asking community members to rate video-taped segments of the interviews.

     

Evaluation of a telehealth parent training program in teaching self-care skills to children with autism

The present study used synchronous video conferencing to remotely deliver a behavioral skills training-based (BST) parent training program to 3 parents of children with autism in the family home. Parents were taught to implement graduated guidance to teach their children several important self-care skills. Parents did not correctly implement graduated guidance after receiving detailed written instructions only. After parents received the BST parent training package, however, all parents implemented graduated guidance with near-perfect levels of fidelity, and all children completed the targeted self-care skills with substantially higher levels of accuracy and independence. Furthermore, parents reported high levels of satisfaction with graduated guidance, the telehealth BST training package, and their children's ability to complete self-care skills.     

TRAINING FAMILY THERAPISTS: AN EXPERIMENTAL ANALYSIS

This study implemented and evaluated a training program (a written manual, videotaped models, rehearsal, role plays, and performance feedback) designed to teach five subjects the skills to become effective family therapists. The study examined the therapists' use of three target behaviors: instructing, informing, and praising. The therapists, each paired with a parent and a preschool-aged child (2 1/2–4 1/2 yr old), were trained in the clinic to use, and to teach to the parents, several behavioral skills (e.g., praising, planned ignoring, and time-out) relevant to teaching children compliance to parental instructions. A multiple-baseline design across triads (therapist/parent/child) demonstrated that after the training program was instituted, the therapists increased their rates of instructing, praising, and informing the parents; all parents increased attention to compliance, decreased attention to noncompliance, and increased rates of praise to their children; and all children increased their compliance and decreased their noncompliance.     

THE EFFECTS OF BEHAVIORAL SKILLS TRAINING ON IMPLEMENTATION OF THE PICTURE EXCHANGE COMMUNICATION SYSTEM

The effectiveness of a behavioral skills training (BST) package to teach the implementation of the first three phases of the picture exchange communication system (PECS) was evaluated with 3 adults who had no history teaching any functional communication system. A multiple baseline design across participants was used to evaluate the effectiveness of the training package, which consisted of a video, written and verbal instructions, modeling, rehearsal, and feedback. Results showed significant improvements relative to baseline in a short amount of training time and that skills generalized to a learner with a severe developmental disability. Skills were maintained at 1 month follow‐up for 1 participant.     

A component analysis of behavioral skills training with volunteers teaching motor skills to individuals with developmental disabilities

This study included a component analysis of behavioral skills training (BST) for teaching volunteers how to use this training method to support individuals with developmental disabilities in a physical education program. In an alternating treatment design embedded within a multiple baseline design across five participants, the number of BST steps that volunteers completed correctly while teaching four motor skills was measured. In the initial training phase, each motor skill was taught to volunteers using a specific component of BST (i.e., instructions, modeling, rehearsal, or feedback). In subsequent training phases, BST components were combined to teach the volunteers the motor skills for which they did not reach a predetermined mastery criterion (a score of four correct responses across two consecutive trials). Maintenance was assessed. Results indicated that individual components of BST alone were sufficient for volunteers to meet the mastery criterion; however, the full BST framework was necessary for skill maintenance. Strengths, limitations, and recommendations for future research are discussed.     

TEACHING CHILD-CARE SKILLS TO MOTHERS WITH DEVELOPMENTAL DISABILITIES

The present study identified and remediated child-care skill deficits in parents with developmental disabilities to reduce their risk of child neglect. Eleven mothers with developmental disabilities who were considered by social service and child welfare agencies to be providing neglectful child care were found in baseline to have several important child-care skill deficits (e.g., bathing, diaper rash treatment, cleaning baby bottles) compared to nonhandicapped mothers. Parent training (consisting of verbal instructions, pictorial manuals, modeling, feedback, and reinforcement) resulted in rapid acquisition and maintenance of child-care skills in all mothers. Mean percentage correct scores increased from 58% in baseline to 90% in training and 91% in follow-up (M = 31 weeks). The latter two scores compare favorably to the mean score (87%) of 20 nonhandicapped mothers on the same skills. Where observable, parent training was associated with corresponding benefits to the children (e.g., elimination of diaper rash and cradle cap, increased weight gain, successful toilet training). These results indicate that parent training may be a viable option to the removal of the child from the home when parenting skill deficits place the child's well-being in jeopardy.     

Using Behavioral Skills Training to Promote the Generalization of Parenting Skills to Problematic Routines

Research has demonstrated the efficacy of a behavioral parent training program for skills acquisition; however, few studies have examined the extent to which those skills generalize to the home or the effect that they have on child behavior. A multiple baseline across participants design was used to assess (a) caregiver accuracy with implementation of three parenting skills, and (b) the effects of the parenting skills on child behavior. Results demonstrated that three caregiver participants successfully generalized parenting skills taught during behavioral skills training (BST) to naturally occurring routines, and the behavior of each caregiver's child improved following BST.     

Functional analysis skills training for residential caregivers

Functional analysis is the most effective assessment for identifying the maintaining contingencies of aberrant behavior. However, it is suggested that functional analyses are not conducted regularly due to the level of skill required. A multiple baseline design across participants was used to assess if four residential caregivers, with limited experience with applied behavior analysis, could be trained to implement the standard analog functional analysis conditions. The training consisted of a lecture, written information, modeling, rehearsal, and feedback. Results showed that all participants attained percentage correct responding scores above 95% on three consecutive trials following training. One caregiver showed positive generalization of skills to the assessment of another behavioral topography. The result of this study provides further evidence that lay individuals can be trained to assist in conducting functional analyses. Copyright © 2008 John Wiley & Sons, Ltd.     

Behavioral skills training in scent detection research: Interactions between trainer and animal behavior

Animal trainers working in scent detection programs are responsible for arranging training contingencies as well as for observing and recording animal behavior. We provided behavioral skills training (BST) to animal trainers working with scent detection rats to improve the treatment integrity of scent‐detection research sessions. We evaluated the trainers' behavior at baseline and during the sequential introduction of each component of BST (instructions, modeling, and feedback). We observed incremental improvements in treatment integrity with the introduction of each BST component. Posttraining probes revealed that these improvements were sustained at least 3 weeks post‐BST. As the trainers' behavior was modified during BST, we observed decrements in measures of rat performance. We discuss the nature of these interactions and their implications for the use of BST in scent detection research and in situations in which intervention with one party produces concomitant effects on the behavior of another.     

The effects of a behavioral skills training and general‐case training package on caregiver implementation of a food selectivity intervention

We used behavioral skills training with general‐case training to teach 3 caregivers to implement a behavioral feeding intervention with their children. The percentage of correctly performed steps of the feeding intervention increased for all 3 caregivers and was maintained at follow‐up. For all 3 children, the number of bites consumed increased and the number of bites with inappropriate mealtime behavior decreased across treatment. Increases in bites consumed and bites without behavior problems were maintained for 2 participants at follow‐up.     

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.