Systematic review of acquisition mastery criteria and statistical analysis of associations with response maintenance and generalization

Behavioral skills training for teaching safety skills to mental health service providers compared to training-as-usual: a pragmatic randomized control trial

BACKGROUND

Violence in the healthcare workplace has been a global concern for over two decades, with a high prevalence of violence towards healthcare workers reported. Workplace violence has become a healthcare quality indicator and embedded in quality improvement initiatives of many healthcare organizations. The Centre for Addiction and Mental Health (CAMH), Canada's largest mental health hospital, provides all clinical staff with mandated staff safety training for self-protection and team-control skills. These skills are to be used as a last resort when a patient is at imminent risk of harm to self or others. The purpose of this study is to compare the effectiveness of two training methods of this mandated staff safety training for workplace violence in a large psychiatric hospital setting.

METHODS

Using a pragmatic randomized control trial design, this study compares two approaches to teaching safety skills CAMH's training-as-usual (TAU) using the 3D approach (description, demonstration and doing) and behavioural skills training (BST), from the field of applied behaviour analysis, using instruction, modeling, practice and feedback loop. Staff were assessed on three outcome measures (competency, mastery and confidence), across three time points: before training (baseline), immediately after training (post-training) and one month later (follow-up). This study was registered with the ISRCTN registry on 06/09/2023 (ISRCTN18133140).

RESULTS

With a sample size of 99 new staff, results indicate that BST was significantly better than TAU in improving observed performance of self-protection and team-control skills. Both methods were associated with improved skills and confidence. However, there was a decrease in skill performance levels at the one-month follow-up for both methods, with BST remaining higher than TAU scores across all three time points. The impact of training improved staff confidence in both training methods and remained high across all three time points.

CONCLUSIONS

The study findings suggest that BST is more effective than TAU in improving safety skills among healthcare workers. However, the retention of skills over time remains a concern, and therefore a single training session without on-the-job-feedback or booster sessions based on objective assessments of skill may not be sufficient. Further research is needed to confirm and expand upon these findings in different settings.

A Meta-Analysis of Self-Management Interventions in Teaching Daily Living Skills to Autistic Individuals

The current study aimed to conduct a systematic review and meta-analysis of self-management interventions for teaching daily living skills to autistic individuals. This study accessed the corresponding studies by doing a search in six databases. 14 articles and one dissertation met the inclusion criteria. The included studies were first analyzed descriptively and coded according to quality indicators using What Works Clearinghouse (WWC) standards. Second, the effect sizes of the included studies were calculated using two different effect size measures (i.e., Tau-U and performance-criteria-based effect size values [PCES]). Third, these analyses were also conducted for generalization and maintenance data. Of 15 studies included in this review, nine met the WWC standards with and without reservations. Tau-U analyses were conducted for 14 studies, whereas PCES values were calculated for only eight studies with mastery criteria. The findings indicated that the self-management interventions had a .93 CI95 (.80, 1) overall effect size for Tau-U with a very large effect. On the other hand, the overall effect size for the PCES values indicated a moderate effect with .99. The weighted effect sizes in generalization and maintenance phases were very large for Tau-U; however, moderate to high effects for PCES. Although self-management interventions showed diversity, one of the domains of daily living skills (i.e., community living skills) has not been studied in the field. Notably, among the studies in our review, the last ones are from 2019. Detailed findings from descriptive analyses and two different effect size calculations are discussed, and recommendations for future studies are given.

Central auditory test performance predicts future neurocognitive function in children living with and without HIV

Tests of the brain's ability to process complex sounds (central auditory tests) correlate with overall measures of neurocognitive performance. In the low- middle-income countries where resources to conduct detailed cognitive testing is limited, tests that assess the central auditory system may provide a novel and useful way to track neurocognitive performance. This could be particularly useful for children living with HIV (CLWH). To evaluate this, we administered central auditory tests to CLWH and children living without HIV and examined whether central auditory tests given early in a child's life could predict later neurocognitive performance. We used a machine learning technique to incorporate factors known to affect performance on neurocognitive tests, such as education. The results show that central auditory tests are useful predictors of neurocognitive performance and perform as well or in some cases better than factors such as education. Central auditory tests may offer an objective way to track neurocognitive performance in CLWH.

Simultaneous Prompting to Teach Intraverbal Synonyms to Struggling Readers

In simultaneous prompting procedures, an immediate (i.e., 0-s) prompt is presented during all training trials, and transfer to the target discriminative condition is assessed during daily probes. Previous research suggests that simultaneous prompting procedures are efficacious and may produce acquisition in fewer errors to mastery when compared to prompt delay procedures. To date, only a single study on simultaneous prompting has included intraverbal targets. The current study evaluated the efficacy of a simultaneous prompting procedure on the acquisition of intraverbal synonyms for six children at risk for reading failure. Simultaneous prompting alone produced responding at mastery levels in seven of the 12 evaluations. Antecedent-based procedural modifications were effective in four of the five remaining evaluations. Errors were generally low for all but one participant. The current findings support the use of simultaneous prompting procedures when targeting intraverbals for young children exhibiting reading deficits.

Differential mastery criteria impact sight word acquisition and maintenance: Application to individual operants and teaching trial doses

We compared the effects of different "mastery" criteria and doses on the acquisition and maintenance of sight words for 4 second graders with and without disabilities. First, we replicated Set Analysis and Operant Analysis conditions where participants were taught sight words in 20-trial (4 operants, 5 opportunities) sessions. Acquisition criteria were applied to a set of 4 operants or to individual operants, respectively. Second, we extended the literature by evaluating a lower dose of the Operant Analysis condition in a 12-trial session (4 operants, 3 opportunities). Thus, we compared 3 conditions-Set Analysis 5, Operant Analysis 5, and Operant Analysis 3. All participants acquired novel sight words fastest and required far fewer teaching trials to maintain each sight word under Operant Analysis 3 compared with Set Analysis 5 and Operant Analysis 5 conditions. Implications for arranging acquisition criteria and the interaction with trial-dosages are discussed.

Effects of stimulus disparity on acquisition of sight word sets: Manipulation of initial letter

Due to the prevalence of words that cannot be read phonetically in the English language, sight word instruction is required to supplement phonics instruction. In this study, we manipulated stimulus disparity in sight word sets by comparing the effects of sets of sight words with the same initial letter (3 words per set, 3 total sets) versus distributing words with the same initial letter across sets when assessing acquisition of the combined set (9 words) for 5 children who ranged from 4-6 years of age using a combined adapted alternating treatments design and pre-posttest design. All participants mastered the 3-word sets in both teaching conditions but did not master the control sets. In general, participants required more teaching sessions when the words in sets began with the same letter. These findings are consistent with stimulus disparity research demonstrating that discrimination training is generally less efficient when comparison stimuli are similar.