End-of-life care in nursing homes: the interface of policy,research, and practice

Much attention has begun to focus on the quality of care for persons near the end of life. Palliative care, especially through hospice, has generated much discussion as possibly the most holistic care available. Consideration of how chronically ill older adults receive such care as a result of public policy can benefit from adopting a multidimensional perspective. This paper adopts Bronfenbrenner's ecological model to understand current end-of-life care for nursing home residents, followed by consideration of how each of these dimensions or levels of influence can be used to foster both research agendas and policy reforms to improve end-of-life care of nursing home residents. Specifically, the benefits of considering the influence of such policy initiatives as the Medicare hospice benefit and the Patient Self-Determination Act (PSDA) on end-of-life care in nursing homes and the means through which policy can be informed by clinical research is emphasized.     

Reducing stereotypic behavior through discrimination training,differential reinforcement of other behavior,and self‐monitoring

The effect of a treatment package designed to reduce stereotypic body rocking was examined in a child diagnosed with autism. After baseline, the participant was taught to discriminate between inappropriate (e.g. sitting in a chair and rocking) and appropriate (e.g. sitting in a chair without rocking) behavior. During intervention, both a therapist and the participant himself monitored the occurrence of rocking behavior. A non‐resetting 5 min differential reinforcement of other behavior (DRO) schedule was also introduced. A multiple baseline across behaviors (sitting and standing) design was used to evaluate the effects of the intervention package. The results indicated that the intervention was effective in eliminating body rocking. In addition, the DRO schedule was successfully increased to 20 min for sitting and 17 min for standing and the treatment was successfully introduced at the child's school. Copyright © 2001 John Wiley & Sons, Ltd.     

Treatment of self‐injury correlated with mechanical restraints

Mechanical arm restraints were used to decrease hand‐to‐head self‐injurious behavior (SIB) exhibited by a 16‐year‐old female with severe mental retardation. Although mechanical restraints reduced hand‐to‐head SIB, they were correlated with an increase in other topographies of SIB (e.g., head banging). These other topographies were not significantly affected by the addition of an environmental enrichment procedure, but were immediately and almost completely suppressed when contingent exercise was added. Copyright © 2001 John Wiley & Sons, Ltd.     

Errors of Omission and Commission during Alternative Reinforcement of Compliance: The Effects of Varying Levels of Treatment Integrity

We conducted two experiments to evaluate the effects of errors of omission and commission during alternative reinforcement of compliance in young children. In Experiment 1, we evaluated errors of omission by examining two levels of integrity during alternative reinforcement (20 and 60 %) for child compliance following no treatment (baseline) versus treatment at full (i.e., 100 %) integrity. Results indicated that compliance varied according to the level of integrity in place. In addition, compliance in the 60 % integrity condition was high and stable when it followed baseline, but was substantially lower for one participant and slightly lower for a second participant when it followed the full integrity condition. In Experiment 2, we evaluated errors of commission. For three participants, we compared treatment at full integrity to a condition in which errors of commission were made on every trial (i.e., 0 % integrity). For one of these three participants, we also compared treatment at full integrity to baseline and to a condition in which errors of commission were made on 50 % of trials. Results of all four evaluations again indicate that compliance varied according to the level of integrity in place: compliance was low in both the 0 and 50 % integrity conditions, regardless of the preceding condition. These results suggest that during alternative reinforcement of compliance, the effect of occasional errors of omission may depend on the immediately preceding context but that errors of commission are more detrimental.     

THE USE OF A VERBAL REPRIMAND TO DECREASE RUMINATION IN A CHILD WITH AUTISM

After a pre‐treatment screening analysis suggested that rumination exhibited by a boy with autism occurred in the absence of social consequences, we evaluated the effect of a verbal reprimand contingent on the target behavior via a reversal design. The reprimand reduced rumination to near‐zero levels; we then thinned the reprimand schedule and rumination remained infrequent. Follow‐up data collected 6, 12, and 18 months after initial treatment suggested that intervention effects were maintained. Copyright © 2014 John Wiley & Sons, Ltd.     

Decreasing bouts of prolonged sitting among office workers

Many workers in industrialized nations spend their day seated at a desk. Research suggests that accumulated sitting time increases risk for certain diseases (van der Ploeg, Chey, Korda, Banks, & Bauman, 2012). To reduce risk, health researchers recommend frequent standing or walking breaks during the workday. In the current study, we evaluated 3 behavioral interventions to decrease bouts of prolonged sitting among office workers. Information alone was not as effective as a treatment package that consisted of a tactile prompt, feedback, and goal setting.     

Conceptualization and Development of the Behavior Analysis Programs at the Florida Institute of Technology

We describe the conceptualization and development of the Behavior Analysis programs at the Florida Institute of Technology (Florida Tech). From its beginnings as a small master’s program in applied behavior analysis (ABA), the Behavior Analysis programs at Florida Tech have now grown to include three Master of Science programs across two campuses, a Ph.D. program in Behavior Analysis, an undergraduate degree (B.A.) in ABA, an online certificate program that has attracted students internationally, and a hybrid (live and online) Master of Arts in Professional Behavior Analysis program at several sites around the USA. These programs are now housed in the first ever School of Behavior Analysis at a Tier 1, nationally ranked private university.     

EFFECTS OF AND PREFERENCE FOR PAY FOR PERFORMANCE: AN ANALOGUE ANALYSIS

We examined the effects of 2 payment systems on the rate of check processing and time spent on task by participants in a simulated work setting. Three participants experienced individual pay‐for‐performance (PFP) without base pay and pay‐for‐time (PFT) conditions. In the last phase, we asked participants to choose which system they preferred. For all participants, the PFP condition produced higher rates of check processing and more time spent on task than did the PFT condition, but choice of payment system varied both within and across participants.