Utilizing in-vivo feedback for caregiver training of pediatric feeding protocols

Researchers have used multicomponent behavioral skills training packages including written and verbal instructions, modeling, rehearsal, and feedback when teaching caregivers to implement pediatric feeding treatment protocols (e.g., Anderson & McMillan, 2001; Seiverling et al., 2012). Some investigators have shown that fewer behavioral skills training components may be necessary for effective training (e.g., Mueller et al., 2003; Pangborn et al., 2013). We examined the use of in-vivo feedback following written instructions to train caregivers to implement pediatric feeding treatment protocols using a multiple baseline design across 3 caregiver dyads. Correct implementation of the feeding treatment procedures was low during baseline (written instructions only), increased with only the addition of in-vivo feedback, and remained high during follow-up sessions for all caregivers. Results are discussed in terms of clinical implications and caregiver satisfaction.     

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.     

Learning to Teach: The Acquisition and Maintenance of Teaching Skills

We reviewed 49 studies which used direct observation procedures to provide data on the effects of pre-service and inservice training in practical classroom teaching behaviors and skills. We found stronger effects for training packages which included classroom practice with performance feedback. The research provided conflicting evidence regarding the value of modeling, role-play, cueing systems, and contingency management components in practical skills training. The weakest training effects were those produced by microteaching, Minicourse, and protocol training packages. Twenty of the evaluations also provided follow-up data but the design of these studies did not permit any conclusions to be drawn regarding the training conditions which are necessary for the maintenance of newly acquired classroom teaching skills. We concluded that identification of the training conditions which are necessary for the maintenance of new teaching skills will require more thoughtful conceptualizations of maintenance and its measurement, and more carefully designed component analyses of those factors suggested by basic research as being necessary for maintenance.     

THE USE OF IMPOSED AND SELF-SELECTED TRAINING PACKAGES TO ESTABLISH CLASSROOM TEACHING SKILLS1

Although much is known about techniques for teaching elementary pupils in the classroom, no procedures have been consistently effective in training teachers to use these techniques. In the present study, six teacher trainees were observed individually and trained sequentially to use a variety of teaching skills: praise for academic responses, praise for appropriate classroom behavior, correction procedures for incorrect academic responses, and token fines. These skills were examined under four conditions: (1) baseline sessions were taught by the trainees before any instructions on the use of the teaching skills. (2) Instruction sessions were taught by the trainees after they were given instructions describing the use of several teaching skills. (3) During each Imposed-Package session, the trainees received modelling, verbal feedback, graphic feedback, and grade and quiz contingencies on their use of a particular teaching skill. (4) During each Self-Selected Package session, a grade contingency was in effect with the trainees choosing the components (modelling, verbal feedback, graphic feedback, quiz contingency) they wanted included in their training package for a particular skill. The effects of instructions were quite varied. Large increases on three of the four skills occurred with one trainee; almost no changes occurred with another trainee; and changes with the remaining four trainees fell within these extremes. The Imposed and Self-Selected Packages reliably increased the use of teaching skills, including those skills for which instructions had not been effective. The Self-Selected Package was considered to be as effective as the Imposed Package, since the time required for training a teaching skill varied from two to nine sessions with both packages. Under the Self-Selected Package, the trainees chose from modelling, verbal feedback, and graphic feedback, but none chose the quiz contingency. Questionnaire data collected after training showed that all six trainees preferred the Self-Selected Package to the Imposed Package. The effectiveness of the Self-Selected Package, together with the trainees' preference for it, suggests that it may be desirable for teacher training programs to specify the teaching skills, arrange a contingency for performance, and allow trainees to choose which additional components are to be used in each training session.     

Review and Discussion of Strategies to Address Low Trainer‐to‐Staff Ratios

Researchers have developed an array of highly adaptable intervention packages with well‐documented efficacy for staff and teacher training. As indicated by Parsons, Rollyson, and Reid (2012) in their article on best practices in staff training, behavior analysts must use methods that are both effective and efficient given the limited resources of many human service settings (e.g., low trainer‐to‐staff ratios). The purpose of this paper is to summarize research on practical innovations for staff and teacher training, including the use of video‐based technology and self‐instruction materials that may help trainers to operate effectively despite limited time and personnel. Results are discussed in terms of the current state of the evidence for each practical innovation and considerations for integrating these strategies with best practices in staff training. Copyright © 2015 John Wiley & Sons, Ltd.     

The effects of training on caregiver implementation of incidental teaching

A brief training package consisting of modeling, rehearsal, and feedback was evaluated to train caregivers to use incidental teaching to teach 3 children with autism to request an item or activity. The training package improved correct implementation of the incidental teaching procedure by caregivers. In addition, probes indicated that caregivers could apply these skills to teach the child an additional skill.     

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.     

Faded Versus Increasing Feedback,Task Variability Trajectories,and Transfer of Training

We assessed the merit of the advice given in the literature to fade feedback over the course of training because it was not based on solid research evidence. In a transfer experiment, we compared the effects of faded versus increasing feedback-provided guidance over the course of training on performers' task variability patterns and the subsequent transfer of effective responses to different task conditions. We found that faded feedback led to a rapid change in the percentage of favorable (vs. unfavorable) task conditions experienced over the course of training, which facilitated the transfer of effective responses to favorable task conditions. Alternatively, increasing feedback-provided guidance resulted in a gradual increase in the percentage of favorable (vs. unfavorable) task conditions experienced over the course of training and more balanced exposure to different task conditions. This facilitated the transfer of effective responses to unfavorable task conditions and more equal transfer of effective responses to favorable and unfavorable task conditions. The results indicated that recommendations to fade feedback over training need to be qualified and have implications for the design of feedback interventions used in training and other developmental activities.     

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.     

COMPONENT ANALYSIS OF BEHAVIOR SKILLS TRAINING IN FUNCTIONAL ANALYSIS

Behavioral Skills Training (BST) is an effective training package that consists of instructions, modeling, rehearsal, and feedback. Although the efficacy of BST has been demonstrated, previous research has not clearly delineated its active components. This study used an alternating‐treatment design embedded within ABC and ABCD designs to evaluate the independent effects of all components of BST for training teachers to conduct functional analyses. Prior to baseline, teachers reviewed written instructions. Following baseline, modeling, rehearsal, and feedback training occurred independently during the first training phase and in combination during subsequent training phases. Rehearsal was ineffective, whereas feedback was effective at improving the performance of all teachers. Modeling was less effective than feedback, such that improvements only occurred for some teachers and some functional analysis responses. Thus, feedback, and to a lesser extent, modeling are the effective and perhaps necessary components of BST. Copyright © 2012 John Wiley & Sons, Ltd.     

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.     

Improvements in early care in Russian orphanages and their relationship to observed behaviors

This article describes a unique study that attempts to promote positive social‐emotional relationships and attachment between caregivers and children in orphanages in St. Petersburg, Russia. The children who reside in these orphanages are typically between birth and 48 months of age; approximately 50% are diagnosed with disabilities, and approximately 60% leave through foreign adoption. Initially, their orphanage caregivers showed a high level of current anxiety and depression and were detached from and communicated little with the children. Likewise, during baseline observations, the children demonstrated poor attachment behaviors such as indiscriminant friendliness, lack of eye contact with adults, aggression, and impulsive behavior. Two interventions were used in a quasiexperimental design: (a) training of caregivers to promote warm, responsive caregiving and (b) staffing and structural alterations to support relationship building, especially increasing the consistency of caregivers. The methodology required that both the training and staffing interventions be provided to one orphanage, only the training to a second, and neither to a third. (At any one time, ns = 80–120 in each condition.) Initial informal observations reveal positive behaviors for both the caregivers and the children, such as increased two‐way conversations, animated and enthusiastic emotional responses, and positive social and language interactions. Early data analyses show an increase in the consistency and stability of caregivers and increased scores for caregivers on every subscale of the HOME Scales. Children showed improvements in physical growth, cognition, language, motor, personal‐social, and affect, with children having severe disabilities improving the most. The implications of these findings suggest that training staff with modest educational backgrounds and structural changes are effective, can increase socially responsive caregiving behaviors, and improves social interactions of children, at least temporarily. ©2005 Michigan Association for Infant Mental Health.     

A comparison of a modified sequential oral sensory approach to an applied behavior‐analytic approach in the treatment of food selectivity in children with autism spectrum disorder

Treatments of pediatric feeding disorders based on applied behavior analysis (ABA) have the most empirical support in the research literature (Volkert & Piazza, 2012); however, professionals often recommend, and caregivers often use, treatments that have limited empirical support. In the current investigation, we compared a modified sequential oral sensory approach (M‐SOS; Benson, Parke, Gannon, & Muñoz, 2013) to an ABA approach for the treatment of the food selectivity of 6 children with autism. We randomly assigned 3 children to ABA and 3 children to M‐SOS and compared the effects of treatment in a multiple baseline design across novel, healthy target foods. We used a multielement design to assess treatment generalization. Consumption of target foods increased for children who received ABA, but not for children who received M‐SOS. We subsequently implemented ABA with the children for whom M‐SOS was not effective and observed a potential treatment generalization effect during ABA when M‐SOS preceded ABA.     

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.     

Training the equidistant principle of number line spacing

The characteristics of effective numerical trainings are still under scientific debate. Given the importance of number line estimation due to the strong relation between task performance and arithmetic abilities, the current study aimed at training one important number line characteristic: the equidistant spacing of adjacent numbers. Following an embodied training approach, second-graders were trained using a randomized crossover design to divide a presented line into different numbers of equal segments by walking the line with equally spaced steps. Performance was recorded, and feedback as to the correct equidistant spacing was provided using the Kinect sensor system. Training effects were compared to a control training with no involvement of task-specific whole-body movements. Results indicated more pronounced specific training effects after the embodied training. Moreover, transfer effects to number line estimation and arithmetic performance were partially observed. In particular, differential training effects for bounded versus unbounded number line estimation corroborate the assumption that not only bodily experiences but also the need for a flexible adaption of the perspective on the training material might influence training success. Hence, more pronounced training effects of the embodied training might stem from different cognitive processes involved.     

The Conditioned Attention Theory and Bifactorial Theory on the Learned Helplessness Syndrome in Appetitive Contexts

The purpose of the present experiment was to explore the theory that deficits in learned helplessness, normally produced by inescapable shock or noncontingent events, are eliminated in subsequent learning discrimination when a combination of exteroceptive cues or feedback stimuli and a predictable stimulus are present. We used 48 pigeons in 6 groups: Group P+C+ training with predictable and controllable events; Group P+U— training with predictable and uncontrollable events; Group U—F training with unpredictable and uncontrollable events and feedback stimulus; Group P+U—F training with predictable and uncontrollable events and feedback stimulus; Group U-RE training with unpredictable, uncontrollable and random events; Group CG did not receive any treatment. Our results demonstrated that a combination of feedback stimuli and predictability was found to be the most effective training against effects of noncontingent events in appetitive contexts.     

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.     

FOCUS on the Family Caregiver: A Problem‐Solving Training Intervention

Problem‐solving interventions have documented effectiveness in treating distress among a variety of clientele. The authors discuss the application of training in social problem solving with family caregivers of persons who have incurred severe physical disabilities. Specifically, the authors outline training procedures (i.e., Project FOCUS) that enable counselors to assist family caregivers in developing effective problem‐solving skills that may translate to increased wellness for each caregiver, and by extension, their care recipients.     

Differential reinforcement of high rate behavior to increase the pace of self‐feeding

Although numerous studies have examined treatments for increasing food consumption among children with pediatric feeding disorders, very few have examined treatment of other mealtime‐related difficulties. One such problem is a slow pace of self‐feeding, which can lead to caregivers failure to adhere to treatments or be disruptive to others. We examined the effects of a differential reinforcement of high rate (DRH) intervention to increase a 9‐year‐old boy's pace of self‐feeding. During treatment, the child received reinforcement contingent on consuming his meal within 30 min. Results showed an increase in the pace of self‐feeding and a concomitant decrease in meal duration as compared to baseline. Copyright © 2008 John Wiley & Sons, Ltd.     

Observational versus feedback training in rule-based and information-integration category learning

The effects of two different kinds of categorization training were investigated. In observational training, observers are presented with a category label and then shown an exemplar from that category. In feedback training, they are shown an exemplar, asked to assign it to a category, and then given feedback about the accuracy of their response. These two types of training were compared as observers learned two types of category structures--those in which optimal accuracy could be achieved via some explicit rule-based strategy, and those in which optimal accuracy required integrating information from separate perceptual dimensions at some predecisional stage. There was an overall advantage for feedback training over observational training, but most importantly, type of training interacted strongly with type of category structure. With rule-based structures, the effects of training type were small, but with information-integration structures, accuracy was substantially higher with feedback training, and people were less likely to use suboptimal rule-based strategies. The implications of these results for current theories of category learning are discussed.