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.     

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.     

Behavioral Interventions and Families: A Medical Rehabilitation Perspective

Behavioral interventions are pertinent to many issues faced by medical rehabilitation patients and their families in late adulthood. Despite their utility in managing chronic illnesses and reducing problematic behaviors related to cognitive impairment, behavioral interventions can be difficult to implement and maintain in a family setting. Problems resulting from countercontrol, caregiver fatigue, conflicting priorities, and impact on family relationships must be anticipated and addressed. These issues are illustrated through references to pertinent research and case examples. Recommendations are offered to reduce caregiver stress and to minimize shifts in relationships when family caregivers act to alter a member's behavior.     

Supervision and training in child care: Does reflective supervision foster caregiver insightfulness?

The goal of this study was to explore the effects of reflective and traditional supervision and training on caregiver insightfulness. Caregiver insightfulness, or caregiver ability to understand “motives underlying the child's behavior in a complete, open, and accepting way” (D. Oppenheim, D. Goldsmith, & N. Koren‐Karie, 2004, p. 352) was assessed at two time points with 21 new caregivers at two university‐based childcare sites. Trends suggest that caregiver insightfulness was relatively stable while increased levels of components of caregiver insightfulness over a period of approximately 2.5 months were positively associated with reflective supervision and training. These findings suggest that encouraging caregivers to reflect on their interactions with the children in their care fosters caregivers' ability to see from the child's perspective in an open and accepting way.     

Introduction: Using Evidence-Based Cognitive and Behavioral Principles to Improve HIV-Related Psychosocial Interventions

Behavioral interventions have been, and continue to be, a cornerstone of efforts to prevent new HIV infections, as well as to improve the physical and mental health of people living with the virus. Most existing efficacious behavioral interventions, many based on the principles of cognitive behavior therapy, have been developed and disseminated to focus on reducing unprotected sex, given that the HIV epidemic in the United States is primarily facilitated through sexual contact, and improving adherence to life-saving HIV medications. The new wave of behavioral HIV interventions builds on that strong foundation by integrating cognitive and behavioral techniques to ameliorate mental health symptoms, focusing content to be culturally tailored to unique subpopulations, and implementing novel delivery methods (telephone, family-based, etc.). The articles that appear in this special series report on the details of several novel, evidence-based, cognitive behavioral interventions related to HIV prevention or treatment.     

Brief Behavioral Intervention for Young Children with Disruptive Behaviors

Parent reported behavioral difficulties in young children are relatively common. Without adequate intervention, some children will later present with more severe problem behaviors. Parent management training is one of the best methods of treatment for behavior problems; however, existing treatments can be lengthy and difficult to conduct outside of a research setting. The Brief Behavioral Intervention was designed as a briefer version of a manualized parent management training treatment package. Thirty-one parents of children aged 2–6.5 presenting with behavior problems were included in this initial study of treatment effectiveness. Based on parent and teacher report, treatment was effective in a mean of 7.2 sessions.     

Behavioral Assessment in DBT: Commentary on the Special Series

Behavioral assessment is woven into the fabric of DBT. The articles of this special series beautifully illustrate this point by describing the relevance and application of behavioral assessment principles in several DBT contexts: creating a case formulation; assessing suicidal behavior; client use of DBT skills; and within family or couple interventions. This commentary highlights themes common to the papers and discusses assessment as it relates to several core concepts in DBT: behaviorism, acceptance, dialectics, and the assumptions about treatment. We identify several dialectical tensions that practitioners must balance when using behavioral assessment strategies. Suggestions for clinical practice are provided.     

Behavioral fluency and mathematics intervention research: A review of the last 20 years

Behavioral fluency refers to the relationship between the achievement of performance standards, or frequency ranges of behavior, and critical learning outcomes. Over the past 20 years, Precision Teaching and related research have contributed a number of studies examining behavioral fluency. The subsequent review investigates the empirical evidence from mathematics intervention research. Several studies suggest numerical markers that best support behavioral fluency. Results indicate that fluency interventions set to performance standards increased behavioral fluency and associated critical learning outcomes; however, more research is warranted to operationalize and standardize each outcome to the principles of behavior and numerical markers that constitute behavioral fluency.     

Contextual Intervention for Caregiver Non-Adherence With Behavioral Intervention Plans

The extent to which parents and other caregivers implement behavioral interventions with integrity has an important impact on treatment effectiveness. This article considers popular interventions that train caregivers and improve treatment integrity in applied behavior analysis. After considering these interventions a contextual approach is described, whereby the function of caregiver non-adherence is considered. In particular, interventions aimed at manipulating setting factors are reviewed. The examples of respite and social support groups are provided as function-based interventions to improve caregiver adherence to behavioral recommendations. Implications for more contextual, coordinated, and comprehensive function-based behavioral services are provided.     

The Accuracy of Behavioral Intention Versus Behavioral Expectation for Predicting Behavioral Goals

Researchers have largely overlooked the distinction between behavioral intention and behavioral expectation as predictors of one's own behavior. Moreover, the distinction between purely volitional behavior and behavioral goals, the latter of which may be impeded by such nonvolitional factors as lack of ability, lack of opportunity, habit, and environmental impediments, has also been blurred in the literature. Behavioral expectation is theorized to be based on a cognitive appraisal of one's behavioral intention and all other behavioral determinants of which one is aware. The present study argues and gives evidence that, although behavioral expectation and behavioral intention may have similar predictive accuracy for volitional behaviors, behavioral expectation is adequate, but behavioral intention may be inadequate for prediction of the accomplishment of behavioral goals.     

Brief Behavioral Activation Treatment for Depressed Adolescents Delivered by Nonspecialist Clinicians: A Case Illustration

Behavioral activation (BA) can be as effective as cognitive-behavioral therapy for the treatment of depression in adults, but to date there is little research with adolescents. This is problematic given the recognized need to increase access to evidence-based interventions for depression in young people. We have developed a new adaptation of brief Behavioral Activation (Lejuez, Hopko, Acierno, Daughters, & Pagoto, 2011) specifically for young people: Brief BA for depressed adolescents. In this paper, we use a case example with session-by-session measurement to show how a nonspecialist clinician can deliver this intervention successfully. We discuss the key themes arising from this training case, challenges the clinician faced, and how these were managed through training and supervision.     

A Cognitive Behavioral Adherence Intervention for Adolescents with Type 1 Diabetes

This study examined the impact of a cognitive behavioral intervention for nonadherent adolescents with type 1 diabetes. Six youths having problems following the diabetes regimen received training in cognitive restructuring and problem solving during individual sessions. A multiple baseline design across participants was used. Treatment effectiveness was assessed through 24-hr recall adherence interviews with adolescents and frequency of testing data was downloaded from glucose meters. Data was also collected for diabetes-specific stress. Five youths displayed improvement on at least one self-care behavior. Furthermore, the results suggest that the cognitive behavioral intervention was effective in diminishing diabetes-related stress in two participants. Cognitive behavioral interventions show promise for increasing self-care behaviors among nonadherent youths with type 1 diabetes. However, individual youths varied in their response to treatment. Further research is needed in developing procedures to better meet the needs of youths, improve youth participation, and enhance treatment effectiveness.     

African American Adolescent-Caregiver Relationships in a Weight Loss Trial

Successful family-based weight loss interventions for African American adolescents are rare. Parent-adolescent interactions supporting adoption of healthier nutrition and physical activity practices are not well understood. African American caregivers' and adolescents' perspectives on how they worked together to achieve weight loss need further exploration. This study describes the relationships experienced by adolescents and caregivers during the 6-month, evidence-based FIT Families weight loss trial and explores differences between families whose adolescents were successful and unsuccessful with weight loss. Exit interviews conducted with 136 adolescents (age 12–16 years; BMI percentile ≥95) and their caregivers (primarily mothers) were taped and transcribed verbatim. Content and thematic analysis was conducted to explore differences between groups stratified by weight loss. Five adolescent-caregiver relationship patterns emerged which describe dyads working together, working alone, working against each other; caregiver support and caregiver working on self. When relationship patterns were compared between groups stratified by weight loss, three themes emerged: motivation, support, and persistence. Families that achieved the greatest weight loss referred more often to working together to reach weight loss goals, attributed their success to adolescent self-motivation, with engaged caregiver support which allowed families to persist in change efforts. Family relationships involving adolescent autonomy, engaged parental support, and persistence despite challenges, clustered differently among adolescents who were successful at weight loss compared to those who were not. Interventionists trained to reinforce effective adolescent-parent interactions will advance behavioral interventions for families who have typically benefited least in prior interventions.     

Cognitive‐Behavioral Tasks Accomplished in a Person‐Centered Relational Framework

The authors propose a person‐centered relational framework in which C. R. Rogers's (1957) core conditions remain the primary catalyst of therapeutic change and cognitive‐behavioral work is accomplished while adhering to person‐centered principles. Important ideas asserted include the following: Cognitive‐behavioral tasks occur naturally within the person‐centered approach, knowledge of cognitive‐behavioral theory can increase counselor empathy, and cognitive‐behavioral techniques can be carefully applied within a person‐centered relational framework. Finally, the person‐centered relational framework with other theories is addressed.     

Behavioral approaches to neuropsychological rehabilitation

Behavioral approaches have been applied to a wide variety of behavioral and cognitive disturbances resulting from brain damage or disease. This article provides a comprehensive and critical review of the literature concerned with behavioral interventions in neuropsychological rehabilitation. The article examines six categories of target behavior: inappropriate social behavior, attention and motivation, unawareness of deficits, memory, language and speech, and motor disturbance. The efficacy of behavioral approaches for treatment of the neurologically impaired and implications for the future role of behavioral approaches in neuropsychological rehabilitation are discussed.     

Interobserver Agreement in Behavioral Research: Importance and Calculation

Behavioral researchers have developed a sophisticated methodology to evaluate behavioral change which is dependent upon accurate measurement of behavior. Direct observation of behavior has traditionally been the mainstay of behavioral measurement. Consequently, researchers must attend to the psychometric properties, such as interobserver agreement, of observational measures to ensure reliable and valid measurement. Of the many indices of interobserver agreement, percentage of agreement is the most popular. Its use persists despite repeated admonitions and empirical evidence indicating that it is not the most psychometrically sound statistic to determine interobserver agreement due to its inability to take chance into account. Cohen's (1960) kappa has long been proposed as the more psychometrically sound statistic for assessing interobserver agreement. Kappa is described and computational methods are presented.     

The Effect of Behavioral Family Intervention on Knowledge of Effective Parenting Strategies

There is a paucity of research considering the effect of behavioral family intervention (BFI) on parenting knowledge and the relative importance of both knowledge and parent confidence in reducing parenting dysfunction and problematic child behavior is unclear. In this study ninety-one parents (44 mothers, 47 fathers) of children aged 2–10?years completed an evidence-based BFI and were assessed at pre and post-intervention on knowledge of effective parenting strategies, parenting confidence, parent dysfunction, and reported intensity of externalised child behavior. Results showed that at pre-intervention parents higher in education (N?=?57) demonstrated greater knowledge than those lower in education (N?=?34). Relative to baseline, parents in both groups significantly improved their knowledge and confidence, reduced their dysfunction and reported less externalised child behavior. Effect sizes for the latter two variables were similar for both groups, however for parents higher in education the effect for confidence was larger than knowledge. Change in level of dysfunction explained the largest amount of unique variance in change to externalised child behavior. Results suggest that for optimal outcomes for parenting and child behavior management more knowledgeable parents may benefit from interventions that focus on practice and consolidation of already learned skills in order to increase confidence whereas for less knowledgeable parents the teaching of new skills and strategies, alongside increasing confidence, are important.     

Culturally Sensitive Dementia Caregiving Models and Clinical Practice

Family caregiving for individuals with dementia is an increasingly complex issue that affects the caregivers' and care recipients' physical, mental, and emotional health. This article presents 3 key culturally sensitive caregiver models along with clinical interventions relevant for mental health counseling professionals.     

Differences in Mothers' and Fathers' Readiness for Change in Parent Training

We investigated readiness for change (RFC), a construct that may contribute to the discrepancies between fathers' and mothers’ rates of participation in behavioral parent training. One hundred and twenty fathers and mothers of 2- to 7-year-old children with conduct problems completed standardized measures of RFC, child behavior problems, and parent stress as part of an intake to a parent-child interaction therapy clinic. Fathers reported less readiness for change, less confidence in their ability to make changes, were more defensive about the need to change, and saw treatment as less important than mothers. Results suggest that if clinicians match parent training interventions to mothers’ readiness, fathers may be left behind.