Use of behavioral techniques by paraprofessional staff: A review and proposal

Paraprofessionals are increasingly being employed to provide direct care to children and adults who have behavioral deficits and excesses, such as those labeled developmentally disabled, mentally ill, or delinquent. Behavioral techniques, if effectively taught to paraprofessionals, offer ways of both teaching new skills to clients and reducing their undesirable behaviors. This article describes the methods that have been used to teach paraprofessionals to use behavioral techniques, how these skills can be maintained on the job, and the effects upon client behavior that result from this teaching of paraprofessionals. In addition, a system for teaching staff to implement and continue to use behavioral techniques is proposed.     

Behavioral staff management: An analogue study of acceptability and its behavioral correlates

This study examined the acceptability of four behavioral staff management techniques: instruction/ modeling, reinforcement, punishment, and self-management. Staff working with developmentally handicapped clients were randomly assigned to these conditions, which were presented in role-plays with a handicapped confederate, while the experimenter directed the management techniques toward the reinforcing behaviors of staff. Dependent variables included number of reinforcers delivered by the staff person, number of problems attempted by the confederate, and ratings of acceptability from staff. Instruction/modeling was most acceptable, followed, in order, by self-management, reinforcement, and punishment. A significant interaction showed number of reinforcers to increase only for instruction/modeling and self-management conditions.     

Acceptability of behavioral interventions: Perceptions of superintendents of public residential facilities

The acceptability of behavioral procedures has been examined with many groups of individuals that have significant roles in the lives of persons with mental retardation. However, for those individuals that live in public residential facilities, one critical person in the decision making process is the superintendent. The purpose of this study was to assess the acceptability of treatments to superintendents of public residential facilities. Using the Treatment Evaluation Inventory (Kazdin, 1980), superintendents rated the acceptability of five treatments (DRO, Time-out, medication, overcorrection and contingent shock) applied to a mild and severe behavior problem. The results showed a significant main effect for treatment and problem and a problem by treatment interaction. Acceptability was inversely related to treatment restrictiveness and, except for differential reinforcement of other behaviors (DRO), all treatments were more acceptable for the severe problem than for the mild problem.     

Changing behavior with behavioral techniques

The following report describes how a combination of reward and punishment was used to change the behavior of an acting-out third grade student. Punishment was used to suppress the undesirable behavior and a reward system was used to reinforce the new desirable behavior. The subject dropped from an average of .20 times per day in getting out his seat to an average of 0.12 over a five-week period.     

Acceptability of positive and reductive behavioral interventions: Factors that influence teachers'' decisions

Treatment acceptability refers to individuals' judgments as to whether psychological treatment procedures are appropriate, fair, and reasonable for a given problem. In the present two-experiment study, experienced teachers' ratings of acceptability for positive (i.e., praise, home-based reinforcement, and token economy) and reductive (i.e., ignoring, response-cost lottery, and seclusion time-out) behavioral interventions were investigated. Using the Intervention Rating Profile (IRP) and a case study methodology to manipulate variables of intervention complexity and problem behavior severity, it was established that (a) teachers' acceptability ratings of both positive and reductive interventions varied with the severity of a target behavior, (b) the complexity of an intervention influenced teachers' ratings of acceptability, less complex or time-consuming interventions being rated generally more acceptable, and (c) mean acceptability ratings were significantly more favorable for positive than reductive treatments. These findings are discussed in the context of previous acceptability research and future investigations.     

Assessing the acceptability of staff management procedures to direct care and supervisory staff

Direct care and supervisory staff in five residential training programs for persons with mental retardation in North Dakota rated the acceptability of six staff management procedures. Overall, staff rated “Instructions”, “Instructions and Modeling”, “Feedback and Praise”, and “Instructions, Feedback, and Praise”, as significantly more acceptable than “Self-Management” and “Self-Management, Feedback and Praise”. There was a significant group by treatment interaction in which supervisors and direct care staff had significantly different acceptability rating for four of the six procedures. The results were further analyzed by group and implications and future research are discuessed.     

Setting up inpatient behavioral treatment programs: The staff needs assessment

Despite the success that behavior therapy has demonstrated in treating severely mentally ill adults, widespread impact of behavioral treatments on this population has been limited because the staff of many inpatient settings do not routinely utilize these strategies. Surveying staff regarding their perception of programatic and organizational needs is proposed as a valuable first step for selecting behavioral strategies to be introduced in these settings. Goldfried and D'Zurilla (1969) developed a behavioral assessment survey that is especially useful for identifying staff needs vis-à-vis behavioral rehabilitation. Using these strategies, survey questions addressed five problem areas: Administrative, Staff, Patient, Resource, and Programatic. Results using this survey with 40 clinicians on the extended care unit of a state hospital showed that staff members had greatest concern with the Patient Problem Area (i.e., aversive patient behaviors that are not sufficiently addressed by treatment plans). Further analyses showed staff members were interested in addressing Patient concerns using incentive procedures. The needs assessment in this study not only provided useful information that might be generalized to other treatment settings, but also showcased a reliable survey approach that program developers might implement prior to designing training curricula for behaviorally naive staff in inpatient settings.     

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.     

Feedback for improving staff training and performance in behavioral treatment programs

This paper reviewed observational studies that examined feedback for changing staff performance in behavioral treatment programs for clients with cognitive, developmental, or psychiatric disorders. The research findings were integrated into the main stages of staff training and management: pretraining, training, and posttraining. Specific recommendations for using feedback are made including defining process and outcome form and content before training, providing on‐the‐job supervisory feedback while staff practice self‐generated outcome feedback until competency is demonstrated, and after training, maintaining self‐generated feedback with emphasis on evaluating staff and client interactions with social validity measures. Copyright © 2008 John Wiley & Sons, Ltd.     

Meta‐analysis of behavioral self‐management techniques used by students with disabilities in inclusive settings

This comprehensive review synthesizes findings from 29 studies in which students with disabilities utilized behavioral self‐management techniques in inclusive settings. Findings suggest that consistent with 2 earlier reviews of these types of studies, most behavioral self‐management techniques continue to be adaptable in inclusive settings with moderate to strong efficacy. This review identifies strengths as well common limitations of the studies, provides recommendations for future research and practice, and includes behavioral self‐management resources.     

Enhancing the training integrity of human service staff using pyramidal behavioral skills training

This experiment used a pyramidal training model to evaluate the effects of behavioral skills training (BST), delivered in a 1-time group-training format, on the extent to which 25 human service staff implemented BST when training others how to implement behavioral procedures. Results indicated that (a) the training workshop increased BST integrity to mastery levels for the majority of participants with varying levels of education, organizational positions, and training experience, (b) the training effects generalized to teaching an untrained skill, and (c) high levels of BST integrity maintained at follow-up 4 to 6 weeks after training for all 3 participants with whom probes were conducted. Moreover, participants indicated high levels of satisfaction with both the training workshop and BST as a training procedure.     

Treatment Acceptability

The present study assessed mothers' and fathers' acceptance of six interventions frequently used to alter children's problem behavior. This is the first study to assess fathers' perceptions of behavioral interventions for children. Positive reinforcement, response cost, medication, room timeout, chair timeout and spanking were rated by parents using the Treatment Evaluation Inventory (TEI). In addition, parents' perceptions of their children's behavior and own marital adjustment were measured using standardized checklists. Parents' acceptability ratings differed significantly across treatment conditions depending on parent gender, child behavior problems, and marital adjustment. Treatment preference order was equivalent for all groups.     

The use of behavioral skills training to improve staff performance of discrete trial training

Well‐trained staff are a prerequisite for successful implementation of treatment plans when working in human service contexts. The high rate of turnover makes the use of efficient and effective staff training all the more important. Previous research has used behavioral skills training to train teachers in correct implementation of discrete trial training of children with autism. They showed that a brief 10‐min procedure could effectively train staff and result in improved performance. The current study elaborated on previous work by using participants without prior exposure to the method, including treatment integrity data and testing for maintenance 1 month after training ended. The mean percentage of correct teaching responses for the three participants increased from 70%, 58%, and 66% during baseline to 97%, 96%, and 99%, respectively, following training. Results indicated that the training package was effective and the results were maintained 30 days later.     

Effect of conducting behavioral observations and ratings on staff implementation of a paired-stimulus preference assessment

We assessed the effects of trainees observing and rating the accuracy of others implementing a paired-stimulus preference assessment from video on the trainees' subsequent implementation accuracy. These observational experiences increased implementation accuracy with both a confederate and an actual consumer. These results suggest conducting observations and accuracy ratings may prepare staff to implement behavioral procedures without need of a dedicated trainer.