Using telehealth to provide outpatient follow‐up to children with avoidant/restrictive food intake disorder

The COVID‐19 global health crisis compelled behavior analysts to consider alternatives to face‐to‐face services to treat children with feeding disorders. Research suggests telehealth is one method behavior analysts could use to initiate or continue assessment of and treatment for feeding disorders. In the current paper, we conducted pilot studies in which we analyzed chart records of patients with Avoidant/Restrictive Food Intake Disorder; who graduated from an intensive, day‐treatment program; and transitioned to an outpatient follow‐up program. In Experiment 1, we analyzed the data of participants who received follow‐up both in‐clinic and via telehealth. In Experiment 2, we analyzed goal attainment for participants who received outpatient follow‐up either in‐clinic exclusively or via telehealth exclusively. Results of both studies showed that outcomes were equivalent along most dimensions for in‐clinic and telehealth services. We provide recommendations for telehealth feeding services and discuss other considerations relevant to telehealth service delivery.     

Evaluating discrete trial teaching with instructive feedback delivered in a dyad arrangement via telehealth

Telehealth research in the field of applied behavior analysis (ABA) has focused on the training and supervision of others to implement various behavior analytic procedures. Current guidelines for practicing telehealth suggest that direct telehealth services may be appropriate for some individuals diagnosed with autism spectrum disorder, but more research is needed. This study evaluated the effects of discrete trial teaching with instructive feedback in a dyad arrangement delivered directly via telehealth to teach tact relations to 6 children diagnosed with autism spectrum disorder. All participants and the experimenter were located in different physical locations. All participants learned their primary and secondary targets, and 5 of the participants acquired the observational primary and secondary targets without direct teaching. Areas of future research and clinical implications are discussed in the context of telehealth service delivery.     

Evolution of Research on Interventions for Individuals with Autism Spectrum Disorder: Implications for Behavior Analysts

The extraordinary success of behavior-analytic interventions for individuals with autism spectrum disorder (ASD) has fueled the rapid growth of behavior analysis as a profession. One reason for this success is that for many years behavior analysts were virtually alone in conducting programmatic ASD intervention research. However, that era has ended. Many investigators from other disciplines are now carrying out large-scale intervention studies and beginning to report successes of their own. The increasing number and range of studies has the potential to improve services for individuals with ASD, and it challenges behavior analysts to intensify their research efforts.     

The effects of transition to technician‐delivered telehealth ABA treatment during the COVID‐19 crisis: A preliminary analysis

Telehealth delivery of applied behavior analysis treatment has focused on supervision or staff and parent training, rather than the direct delivery of treatment to clients. The novel coronavirus (COVID‐19) crisis had the potential to significantly disrupt access to direct treatment for individuals with autism. We report a sample of 17 cases that transitioned from in‐person to telehealth delivery of treatment when shelter‐in‐place orders were issued. Of these cases, 76% of participants transitioned to technician‐delivered telehealth services whereas the rest transitioned to a caregiver‐implemented telehealth model. Participants continued to access a similar dosage of treatment hours per week in spite of the treatment model transition (in‐person M = 12; telehealth M = 11) and maintained or improved correct independent responding across all targets from in‐person treatment (M = 75%) to telehealth treatment (M = 80%). These findings provide initial evidence that some clients with autism benefit from technician‐delivered telehealth services.     

Being Mindful About the Assessment of Culture: A Cultural Analysis of Culturally Adapted Acceptance-Based Behavior Therapy Approaches

In this article we review a wide range of cultural adaptations of acceptance-based behavior therapies (ABBT) from a cultural perspective. Consistent with the cultural match model, we argue that psychotherapeutic cultural adaptations are more effective as the cultural characteristics of patients are matched to the cultural characteristics of the intervention. Cultural match model is then used to examine ABBT cultural adaptations. Overall we conclude that the studies herein included are a promising first step to develop culturally competent ABBTs.     

Interventions for children and adolescents who stutter: A systematic review,meta-analysis,and evidence map

PurposeThis systematic review critically appraises and maps the evidence for stuttering interventions in childhood and adolescence. We examine the effectiveness of speech-focused treatments, the efficacy of alternative treatment delivery methods and identify gaps in the research evidence.MethodsNine electronic databases and three clinical trial registries were searched for systematic reviews, randomised controlled trials (RCTs) and studies that applied an intervention with children (2–18 years) who stutter. Pharmacological interventions were excluded. Primary outcomes were a measure of stuttering severity and quality assessments were conducted on all included studies.ResultsEight RCTs met inclusion criteria and were analysed. Intervention approaches included direct (i.e. Lidcombe Program; LP) and indirect treatments (e.g. Demands and Capacities Model; DCM). All studies had moderate risk of bias. Treatment delivery methods included individual face-to-face, telehealth and group-based therapy. Both LP and DCM approaches were effective in reducing stuttering in preschool aged children. LP had the highest level of evidence (pooled effect size=-3.8, CI -7.3 to -0.3 for LP). There was no high-level evidence for interventions with school-aged children or adolescents. Alternative methods of delivery were as effective as individual face-to-face intervention.ConclusionThe findings of this systematic review and evidence mapping are useful for clinicians, researchers and service providers seeking to understand the existing research to support the advancement of interventions for children and adolescence who stutter. Findings could be used to inform further research and support clinical decision-making.     

Training of interventionists and cultural adaptation procedures: A systematic review of culturally adapted evidence-based parenting programs in Africa

There has been an increase in the implementation of evidence-based parenting programs from high-income countries to several African countries. In this review, we systematically evaluated intervention studies of culturally adapted parenting programs in nine African countries with the objective of examining the quality of training for interventionists and cultural adaptation procedures. A total of 18 studies, obtained from an electronic search of 6 databases, met the inclusion criteria and were evaluated following PRISMA guidelines. The Ecological Validity Model was adopted to organize data on cultural adaptation procedures. Sixteen of the 18 studies reported information regarding the clinical training of interventionists and the cultural adaptations undertaken. Live and interactive workshops were the most common format used to train interventionists in the focal intervention. Overall, cultural adaptations in most studies included translation of intervention protocols into the local language. However, studies varied in the way cultural adaptation procedures were reported with some studies failing to report on cultural adaptation procedures. Concurring with previous literature, attending to issues of culture, power, privilege, access, sustainability, and other relevant concepts to increase the cultural relevance is highly encouraged in parent intervention studies in Africa. This review provides a baseline upon which future training and adaptation procedures can be built.     

Preliminary evidence on the use of telehealth in an outpatient behavior clinic

Previous studies have shown that telehealth can be an effective way to deliver behavior‐analytic services. In this study, we provided a demonstration of the use of telehealth to assess and initiate treatment of problem behavior in an outpatient clinic. We coached parents of children with autism via telehealth to conduct functional analyses during 1 appointment that lasted 1 hr and subsequently coached them as they implemented functional communication training during 3 subsequent appointments (15 min each). Social functions were identified for most children, and problem behavior was reduced by an average of 65.1%.     

Making Lemonade out of Lemons: Dialectical Behavior Therapy via Telehealth During a Pandemic

The COVID-19 pandemic has created a burden on healthcare systems and increased demand for mental healthcare at a time when in-person services are limited. Many programs offering dialectical behavior therapy (DBT) for complex clients have pivoted to telehealth in order to increase access to critical mental healthcare. There is, however, limited research on the provision of telehealth treatment for clients with complex psychopathology more broadly, or the telehealth implementation of DBT more specifically. The aim of this study was to examine the use of telehealth services and related clinician attitudes and experiences in the context of DBT. We examined the degree of telehealth platform adoption among DBT clinicians, as well as changes in stress and self-care strategies. A supplemental aim was to gather clinicians’ recommendations for providing DBT via telehealth. Participants included N = 99 DBT practitioners (79.8% female; 20.2% male). Qualitative and quantitative methods were used for data analysis. Findings show that telehealth DBT has been widely adopted among DBT clinicians, and that clinicians’ attitudes to telehealth DBT are cautiously optimistic. Participants described three main areas of stress associated with DBT via telehealth provision, as well as lost and novel self-care strategies.     

Relative preferences for edible and leisure stimuli in children with autism

Prior researchers have reported a tendency for individuals with developmental disabilities to select edible items more often than leisure items when those items are presented together in stimulus preference assessments. However, children with autism spectrum disorders (ASD), with whom many behavior analysts currently practice, are underrepresented in this body of literature. We conducted a replication of prior research with 26 children with ASD. Results indicated that edible items were more likely than leisure items to rank highly in our preference assessments, in concurrence with prior research. However, leisure items were also selected more often overall than in prior research, and significant individual variation was observed. These results suggest that preference assessments containing both edible and leisure stimuli can yield useful information for behavior analysts providing services to children with ASD, and the degree of preference for edible items noted in prior work may not be reflected in this contemporary population.     

Cultural and Telehealth Considerations for Trauma‐Focused Treatment Among Latinx Youth: Case Reports and Clinical Recommendations to Enhance Treatment Engagement

Given that trauma exposure among youth, particularly those from communities of color, is high, there is a dire need to improve trauma-focused treatment for young people of color. Growing research has documented that integrating cultural and telehealth considerations into trauma-focused treatment can enhance treatment engagement and lead to positive treatment outcomes. Therefore, the purpose of this paper is to demonstrate how to incorporate cultural and telehealth considerations concurrently to enhance treatment engagement for Latinx youth and their caregivers. Specifically, we describe the process of delivering Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) to three trauma-exposed Latinx youths through the use of telehealth technology. Clinical recommendations are discussed to improve treatment engagement of Latinx youth and other young people of color.     

Assessing the social validity of telehealth-based applied behavior analysis services for autism spectrum disorder

During the COVID-19 pandemic, applied behavior analysis services for many autistic individuals were transitioned to telehealth. The current study assessed caregiver-reported quality of life (QoL) and social validity for families of autistic children receiving only telehealth services (n = 96) or a combination of telehealth and in-person services (n = 173). Barriers to the telehealth experience were analyzed via an ANOVA, and the impact of funding source was analyzed using an independent samples t-test. Caregivers reported benefit across QoL and social validity items, with scores ranging from 3.31 to 4.44 (1 = least benefit, 5 = most benefit). While many caregivers reported no barriers regarding technology (44.61%), childcare (69.52%), and employment (64.68%), the presence of those barriers significantly impacted QoL and social validity scores. Funding source was not found to have a significant impact. Overall, caregivers found value in their child's telehealth services. Clinicians have an obligation to mitigate barriers to ensure the success of the intervention.     

Rehabilitation of the Culturally Different: A Model of the Individual in Cultural Change

Services of rehabilitation agencies and facilities tend to be structured to the needs of the larger American culture. It is important, however, to reconsider our social service programs in view of the needs of different cultural groups when providing services that will aid these individuals to move across cultural boundaries. An attempt is made in this paper to develop a model of the individual who undergoes such cultural transition. Such a model should help define problems in service programs, assess the value of current service activities, and identify areas for developing new services that will aid the overall process of cultural transition. A model of behavior development is outlined, followed by a formulation of a model of the individual in cultural change.     

Sociocultural studies of families of children with intellectual disabilities

This article reviews recent sociocultural studies of families of children with intellectual disabilities to introduce the range of research conducted from this perspective and to highlight the methodological, conceptual, and theoretical contributions of this approach to the study of mental retardation. Sociocultural studies examine families within their cultural, historical, and sociopolitical contexts. This type of research is comparative across different cultural groups, but is not limited to such comparisons. Sociocultural studies use varied theories and methods, but they share a focus on families' coproduction of meanings and practices related to intellectual disability; families' responses and adaptations to disability; and how their understandings and experiences are shaped within larger social institutions and inequities. Sociocultural approaches take into account community contexts that matter to families with members with mental retardation or developmental delay, and they examine the broader systems that define and position individuals with disabilities and their families. As a whole, these studies provide a more experiential and holistic view of families' beliefs and adaptations within sociopolitical worlds, and offer new tools by which to study the families of children with developmental delays within and across different cultural groups.     

Conceptualizing Self-determination from a Behavioral Perspective: The Role of Choice,Self-control,and Self-management

The goal of education can be defined in many ways; but in searching the literature, we found that in most cases, people consider the goal of education to be developing a self-determined individual. Self-determination is an abstract term. Behavior analysts may find this term difficult to define. Therefore, it may be difficult to observe and measure whether “self-determined behaviors” have developed. Many other service providers use this term frequently; thus, behavior analysts working with these service providers must come to terms with this concept in order to better collaborate. We argue that self-determination can be operationally defined with the concepts of choice, self-control, and self-management. By using the measurable behaviors included in these concepts, we believe that services can be developed to teach self-determination skills. This paper explores these concepts and how they can contribute to an operational definition of self-determination, and ultimately, help behavior analysts work with other providers to effectively teach self-determination to individuals with developmental disabilities.

     

文化差异视角下个体合作行为的产生、影响机制建构及认知神经基础

合作行为是指个体或群体之间为了实现共同的目标和利益而进行的协同行为或意向。本文基于行为-认知-大脑的三重映射关系,对合作行为的文化差异性进行了深入阐释,并在此基础上构建了文化影响合作行为的社会认知中介模型;未来研究可从实证视角对合作行为文化差异的社会认知内容、认知神经机制等方面进行验证、挖掘和改善。     

Domestic violence and sexual assault services: Inside the black box

Research examining the efficacy of community-based domestic violence and sexual assault services is yielding promising findings; however, little is known about the structure, components, and content of these services. Although service guidelines exist, a critical gap persists because review, comparison, and synthesis of these recommendations have not been undertaken. This research addresses this knowledge gap through a review of the domestic violence and sexual assault services literature. We gathered relevant literature by conducting systematic searches of databases, and by soliciting the service guidelines and training manuals from all the Domestic Violence and Sexual Assault Coalitions in the United States. These efforts yielded 43 articles, books, or manuals for review. The findings show strong consensus on core services for survivors, including crisis services, legal and medical advocacy, support groups, individual counseling, and shelter. This article presents the review results in tables comparing the service goals, intervention strategies, and recommendations for service delivery. We also found areas of contention (e.g., whether to continuously staff domestic violence shelters, and whether combined agencies can effectively offer both domestic violence and sexual assault services). Building upon the review findings, we discuss the implications for domestic violence and sexual assault services and intervention research.     

Collectivism and coping: Current theories,evidence, and measurements of collective coping

A burgeoning body of cultural coping research has begun to identify the prevalence and the functional importance of collective coping behaviors among culturally diverse populations in North America and internationally. These emerging findings are highly significant as they evidence culture's impacts on the stress‐coping process via collectivistic values and orientation. They provide a critical counterpoint to the prevailing Western, individualistic stress and coping paradigm. However, current research and understanding about collective coping appear to be piecemeal and not well integrated. To address this issue, this review attempts to comprehensively survey, summarize, and evaluate existing research related to collective coping and its implications for coping research with culturally diverse populations from multiple domains. Specifically, this paper reviews relevant research and knowledge on collective coping in terms of: (a) operational definitions; (b) theories; (c) empirical evidence based on studies of specific cultural groups and broad cultural values/dimensions; (d) measurements; and (e) implications for future cultural coping research. Overall, collective coping behaviors are conceived as a product of the communal/relational norms and values of a cultural group across studies. They also encompass a wide array of stress responses ranging from value‐driven to interpersonally based to culturally conditioned emotional/cognitive to religion‐ and spirituality‐grounded coping strategies. In addition, this review highlights: (a) the relevance and the potential of cultural coping theories to guide future collective coping research; (b) growing evidence for the prominence of collective coping behaviors particularly among Asian nationals, Asian Americans/Canadians and African Americans/Canadians; (c) preference for collective coping behaviors as a function of collectivism and interdependent cultural value and orientation; and (d) six cultural coping scales. This study brings to light the present theoretical and methodological contributions as well as limitations of this body of literature and the implications it holds for future coping research.     

Serving Culturally Diverse Children with Serious Emotional Disturbance and Their Families

Over the coming decades, we can expect that cultural diversity will abound within the U.S. population and the imagery of an American melting pot will long be discarded. One significance of this trend will be the imperative to account for cultural diversity in assessing the needs of children with serious emotional disturbance (SED), to ensure that assessments, diagnoses, and treatments are accurate, fair, and meaningful. To achieve that end, however, will first require that all persons in the fields of education, mental health, social services, and juvenile justice become fully prepared to support children with SED and their families, prepared to bring to the process a sophisticated understanding of the interplay between culture and social behaviors. Nothing less than that level of preparedness will enable practitioners to develop unbiased interventions that competently and sensitively weigh cultural influences and target the needs of diverse students with emotional and behavioral difficulties. In this paper, we present the need for culturally competent practitioners in the area of SED, ways in which service providers can increase their cultural knowledge, and strategies for more effective service with this population.