Virtual Training of Medical Students to Promote the Comfort and Cooperation of Patients with Neurodevelopmental Disabilities

Patients with neurodevelopmental disabilities generally have less access to necessary medical care compared to those without disabilities. Barriers to adequate care include patient fear and uncooperative behavior during routine medical procedures and inadequate preparation of medical professionals to treat this population. Researchers have identified multiple behavior-analytic procedures for promoting comfort and cooperation during medical treatments. Efficient, cost-effective training programs are needed to widely disseminate behavior-analytic procedures to medical students and professionals. The purpose of this study was to assess the efficacy of a virtual training to prepare medical students to implement behavioral procedures that could be easily incorporated into typical wellness examinations. Seven medical students received behavioral skills training (BST) delivered remotely via the Internet. Results showed that the training successfully increased students' correct implementation of the procedures in roleplay with the experimenter and with patients with neurodevelopmental disabilities. Responding also maintained at high levels 2 weeks after the training. These findings suggest that virtual BST is an efficient, practical approach for training health care professionals to implement general behavior management strategies to increase the comfort and cooperation of patients with NDD.

Evaluating Remote Behavioral Skills Training of Online Gaming Safety Skills

This study assessed the use of behavioral skills training for teaching online safety skills to two children, 7 and 9 years old. In situ assessments took place while playing the popular online game, Among Us, and consisted of confederates presenting lures to the child participants. Before training, the participants scored 1s and 0s, indicating a lack of online gaming safety skills. Both participants scored at mastery criterion (i.e., three scores of 3 in a row) following training. During the first 2-week follow-up, one participant scored a 1 because he did not leave the game following the presentation of a lure; his mother immediately implemented in situ training (IST). He scored at mastery criterion during the next follow-up assessment, indicating the effectiveness of the caregiver-implemented IST. The second participant scored a 3 during his 2-week follow-up.

A Survey of Safety Skills Training Used by Behavior Analysts in Practice

This survey study examines the clinical practices and opinions of Behavior Analyst Certification Board (BACB) certificants regarding safety skills training with their clients with neurodevelopmental disabilities. This article focuses on five safety threats: abduction, sexual abuse, poisonous substances, firearms, and fire-starting agents. Respondents were asked to rate the importance of teaching their clients safety skills for each of these safety threats. Furthermore, the survey included questions pertaining to the use of behavioral interventions, notably behavioral skills training. Results from this preliminary survey of BACB certificants (N = 695) are included and we provide a discussion of current practices and recommendations for future research related to safety skills training among practitioners in clinical settings.

Using Behavioral Skills Training to Teach Functional Assessment Interviewing, Cultural Responsiveness, and Empathic and Compassionate Care to Students of Applied Behavior Analysis

Within the field of applied behavior analysis, there is a recognized need for increased training for practitioners on cultural responsiveness, as well as to improve behavior analysts' demonstration of compassion and empathy towards the families with whom they work. The present study used behavioral skills training via telehealth to teach three skillsets-functional assessment interviewing, empathic and compassionate care, and cultural responsiveness. Participants were seven graduate students who had no previous coursework in behavioral assessment and whose caseload mainly included clients who did not share the participant's cultural, ethnic, or religious backgrounds. The results showed that behavioral skills training was effective in improving performance across all three skillsets. In addition, high levels of responding maintained following the completion of the training for the majority of the participants. Several levels of social validity measures support the utility and impact of this training. The findings have implications for training practitioners on these vital skills.

Preparing Law Enforcement Officers to Engage Successfully with Individuals with Autism Spectrum Disorder: An Evaluation of a Performance-Based Approach

Law enforcement officers (LEOs) may use physical force unnecessarily or escalate problem behavior when attempting to gain the compliance of individuals with autism spectrum disorder (ASD) (Copenhaver & Tewksbury in American Journal of Criminal Justice 44:309-333, 2019). Although specialized training may remedy this problem, the relatively small literature on such training programs indicates the need for further research (Railey et al. in Focus on Autism and Other Developmental Disabilities, 2020). This study used simulations with actors to evaluate the outcomes of performance-based instruction on strategies to promote compliance when LEOs respond to calls involving individuals with ASD. Results for three LEOs and 24 police cadets demonstrated the efficacy of behavioral skills training (BST) for teaching LEOs how to interact more effectively with individuals with ASD. Results also suggested that hands-on training should supplement commonly used forms of didactic instruction.

An Evaluation of Virtual Training for Teaching Dance Instructors to Implement a Behavioral Coaching Package

Few dance instructors receive formal training on how to teach dance skills using behavioral coaching methods and may employ an authoritarian teaching style that utilizes coercive feedback, which can adversely affect dancers' experiences. A behavior analytic approach to dance education may provide dance instructors with strategies that increase the accuracy of dance movements and positively affect dancers' satisfaction with their dance classes. Using a concurrent multiple-baseline design across five dance instructors, we evaluated the outcomes of a virtual training informed by the behavioral skills training framework on dance instructors' implementation of an introductory behavior analytic coaching package consisting of four strategies: task analyzing, emphasizing correct performance with focus points, assessing performance through data collection, and using behavior-specific feedback. We selected these strategies to provide dance instructors with a solid foundation to behavioral coaching methods. It is promising that all dance instructors who participated in virtual training met mastery criteria and maintained their performance at a 1-month follow-up. Future research may consider exploring virtual adaptations that promote more efficient training methods for teaching dance instructors to implement behavioral coaching methods.

Evaluation of a Telehealth Parent-Training Program in Japan: Collaboration with Parents to Teach Novel Mand Skills to Children Diagnosed with Autism Spectrum Disorder

This study developed a telehealth parent-training program to teach parents of children with autism spectrum disorder the process of mand-training implementation in Japan, and to further the international dissemination of evidence-based training strategies. Parent-training sessions were based on a behavioral skills training (BST) model, combined with weekly graphic and video feedback. The sessions were conducted by a board-certified behavior analyst-doctoral residing in Japan. Four parents with children with autism spectrum disorder participated in this study. The results preliminarily support the effectiveness and social validity of the program. This study extends previous parent-training research conducted in Japan by comprising all of the following features: (1) online program design; (2) mand training; (3) BST model; (4) session-by-session data on children's behavioral changes and procedural integrity; (5) within-subject experimental design; and (6) social validity evaluation.

Teaching Compassion Skills to Students of Behavior Analysis: A Preliminary Investigation

Socially valid practices are at the heart of applied behavior analysis and can influence how interventions are experienced by families. However, the training of practitioners of applied behavior analysis is primarily focused on the implementation of technical procedures with little focus on therapeutic approaches. Empathy and therapeutic rapport have been associated with improved outcomes in allied professions (Beach et al., Journal of the American Board of Family Practice, 15(1), 25-38, 2006; Hojat et al., Academic Medicine, 86(3), 359, 2011; Horst et al., Journal of Child & Family Nursing, 3, 5-14, 2000), but have been minimally studied within the field of behavior analysis. In the present study, several sources were utilized to identify and define empathic and compassionate care skills. These skills were divided into three skill areas (i.e., basic interviewing skills, interest in the family, joining with the family) and taught to ABA master's students using behavioral skills training via a telehealth platform. All four participants significantly improved their engagement in compassionate care skills following training and maintained these skills in follow-up probes and with a different experimenter. Several post-study measures of outcome were taken, including social validity measures from participants, ratings of compassion from consumer and professional experts, as well as comparison measures on the Jefferson Scale of Physician Empathy. Participant reports of social validity were high, as were consumer and professional ratings of compassionate behaviors. Improvements on the Jefferson Scale of Physician Empathy were also observed. Implications for training practitioners and for expanding the focus on compassionate care skill development within the field are explored.

Teaching Graduate Students to Identify and Adhere to Practicum Requirements

A critical component of becoming eligible to sit for the Behavior Analyst Certification Board (BACB) exam is the completion of fieldwork experience hours according to the BACB Experience Standards (2018). The accrual of experience hours must meet stringent criteria and is strongly recommended to be documented using the BACB Fieldwork Tracker. Thirteen graduate students in behavior analysis were taught to enter data into the BACB Fieldwork Tracker using mock fieldwork scenarios. Training was conducted using group behavioral skills training. The training occurred remotely using both synchronous and asynchronous components. Of the 13 participants, 11 showed improvement from baseline, and 10 met and maintained performance at mastery levels at the end of the study. Social validity scores indicated that most participants felt the training was helpful, and they reported lower levels of fieldwork accrual-related stress following training (81.8% and 72.7%, respectively). Limitations and areas for future research are discussed.

Teaching Adults with Neurodevelopmental Disabilities to Interact Successfully with Others in a Virtual Format

As a result of the COVID-19 pandemic, individuals with neurodevelopmental disabilities (NDD) are engaging more with others in virtual group formats for social, educational, and professional reasons. This study extends prior research by evaluating the efficacy of common behavioral interventions, including behavioral skills training, provided via group video conferencing to teach skills that are important when interacting with others in a virtual format. Four adults with NDD were taught to use their cameras and microphones appropriately and to make encouraging statements to one another while discussing current events and social skills-based lessons via Zoom™. Two of the three skills increased and maintained for all participants even after the experimenter faded the contingencies for appropriate responding. The third skill maintained after the experimenter arranged for the response to produce natural consequences. Tests for generalization across group leads and activities yielded promising results. Findings suggest that adults with NDD benefit from group-based telehealth services to improve skills needed to interact successfully with others in a virtual format.

Teaching Safety Skills to Children: A Discussion of Critical Features and Practice Recommendations

Children may encounter safety threats from the physical environment (e.g., firearms or poisonous substances) or from the behaviors of others (e.g., abduction or sexual abuse lures). Such encounters may result in injury or death if children do not learn skills to respond safely. Research over the last 40 years has investigated approaches to assessing and training safety skills. This article discusses critical features that have emerged in the research related to best practice for assessing and training safety skills. We emphasize the importance of in situ assessments, effective training approaches, the need for data-based decision making, strategies for enhancing generalization and maintenance, the accessibility of training programs, and approaches to training individuals with disabilities. Following a discussion of each critical feature presented in this article, we provide recommendations for practicing behavior analysts.

The Use of Behavioral Skills Training to Teach Components of Direct Instruction

Behavioral skills training (BST) has been demonstrated to be an effective method for training staff to perform skills with high fidelity in a relatively short amount of time. In the current study, three components of direct instruction (DI) were trained using BST. The participants were two classroom instructors with prior experience implementing DI with students with autism. The targets for staff training were accuracy with signal delivery, error correction, and delivery of praise. A multiple-baseline design across skills was used to evaluate the effects of BST for each participant. Generalization probes were conducted with a student with autism during baseline and after mastery with each skill was demonstrated. BST rapidly increased staff performance across skills, with generalization demonstrated during classroom probes. This study extends the use of BST to training staff to implement DI, and the results suggest that BST resulted in improved teacher performance of the targeted skills during generalization probes with students.

Evaluation of Caregiver Training Procedures to Teach Activities of Daily Living Skills

Caregivers of children with an autism spectrum disorder are often responsible for assisting their children to complete activities of daily living skills. Effective and efficient caregiver training methods are needed to train caregivers. The present study used two concurrent multiple-baseline across-participants designs to evaluate the effects of real-time feedback and behavioral skills training on training eight caregivers to implement teaching procedures for activities of daily living skills with their child. We assessed caregivers' accuracy and correct implementation of the six-component teaching procedure after they received either real-time feedback or behavioral skills training. Caregivers from both groups mastered and maintained correct implementation of the teaching procedures with their child. The overall results suggest that real-time feedback and behavioral skills training are efficacious to train caregivers to implement activities of daily living skills procedures with their children, and that real-time feedback may be an efficient alternative method to train caregivers.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40617-020-00513-z.

Transitioning ABA Services From in Clinic to Telehealth: Case Study of an Indian Organization's Response to COVID-19 Lockdown

Due to the coronavirus (COVID-19) pandemic, around the middle of March 2020, in-clinic intervention services based in applied behavior analysis provided to children had to be stopped abruptly in India. This qualitative and quantitative case study details how Behavior Momentum India (BMI), an organisation providing ABA-based interventions, transitioned services from in clinic to telehealth while continuing to target each student's skill acquisition goals in language and communication domains. A cohort of 92 students diagnosed with autism or other learning disabilities participated in this study; 51 therapists, 9 behavior supervisors, and a doctoral-level Board Certified Behavior Analyst collaborated with parents; 78% of the students and 82% of the therapists used smartphones; and only a few used iPads and laptops. Therapists conducted direct sessions and parent-mediated sessions with 82 students. With 10 students, behavior supervisors trained parents to implement interventions with their children. The critical transition decisions, logistics, and ethical challenges were identified using qualitative methods. Despite significantly reduced session durations, all students continued to acquire targeted skills, and 52% of the students acquired more skills in telehealth compared to in clinic. A parent satisfaction survey returned high ratings onour organization's initiative, and 72% of the parents reported that their familiarity and confidence with the science of applied behavior analysis had increased.

Partially Automated Training for Implementing, Summarizing, and Interpreting Trial-Based Functional Analyses

Trial-based functional analysis (TBFA) is an accurate and ecologically valid assessment of challenging behavior. Further, there is evidence to suggest that individuals with minimal exposure to behavior analytic assessment methodology (e.g., parents, teachers) can quickly be trained to conduct TBFAs in naturalistic settings (e.g., schools, homes). Notwithstanding, the response effort associated with training development can be prohibitive and may preclude incorporation of TBFA into practice. To address this, we developed a partially automated training package, intended to increase the methodology's accessibility. Using a multiple-probe across skills design, we assessed the degree to which the package increased caregiver accuracy in (a) implementing TBFAs, (b) interpreting TBFA outcomes, and (c) managing TBFA data. Six caregivers completed this study and all demonstrated proficiency following training, first during structured roleplays and again during assessment of their child's actual challenging behavior.

Consideration of Both Discriminated and Generalized Responding When Teaching Children with Autism Abduction Prevention Skills

We taught three children with autism how to respond to abduction lures presented by strangers. We then tested undesirable generalization of the safety response to matched instructions to leave by a familiar adult. Following training, all three participants engaged in the safety response across both strangers and familiar adults. Thus, we evaluated a set of procedures for establishing discriminated responding. Appropriate responding to instructions to leave by strangers versus familiar adults was achieved only after discrimination training. Discriminated responding occurred across a novel setting and maintained across 3 months; however, performance during stimulus generalization probes within community settings was variable.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40617-020-00541-9.

Training Preservice School Psychologists to Conduct a Stimulus Preference Assessment

There is limited research evaluating behavioral skills training (BST) in university classrooms to teach stimulus preference assessments. We evaluated the effects of BST on three preservice school psychologists' performance with the multiple-stimulus without-replacement preference assessment. A single BST session improved performance across participants, and improvements were maintained 1 week after BST. Limitations, directions for future research, and suggestions for maximizing the efficiency of BST in university classrooms are discussed.

Scaling Up Behavioral Skills Training: Effectiveness of Large-Scale and Multiskill Trainings

We used behavioral skills training (BST) to teach multiple skills to 2 cohorts of 18 participants. BST consisted of the standard 4 components: (a) didactic instruction, (b) modeling, (c) role-play, and (d) feedback, modified to be delivered in a large-group format. All components were provided by 1 trainer, simultaneously to all participants, with peers delivering feedback during role-plays. Across 4 targeted skills (e.g., discrete-trial teaching), the average performance of Cohort 1 improved from less than 60% correct implementation in baseline to a performance of between 85% and 100% correct, across participants, following BST. We used social validity data collected from Cohort 1 to modify the length of instruction across skills for Cohort 2. BST was similarly effective for Cohort 2, with a decrease in the additional training required for trainees to demonstrate the skill in a novel role-play scenario or with a client. Implications for effectively scaling up BST are discussed.

Use of an Online Training with Virtual Role Play to Teach Preference Assessment Implementation

Identification of reinforcers is critical to the effectiveness of behavioral interventions. Stimulus preference assessments (SPA) are a frequently used method to identify putative reinforcers. Given the fluctuating nature of individual preferences, there is need for efficient training of providers that may regularly implement SPAs. The present study evaluated the utility of a web-delivered training with virtual role play to train SPA implementation. This study builds upon previous literature by utilizing a larger sample and incorporating role-play, a component often omitted from other efficient methods of training. Study 1 trained 40 undergraduate students to implement an SPA via web or in vivo. Results suggest both trainings were equivalently effective, and the web-delivered training reduced trainer time by approximately 25 min. Live role-play and feedback was still necessary with web-delivered training, consistent with suggestions that rehearsal and feedback is a vital component of training. Results also suggest web-delivered training may identify areas of weakness following training. A follow-up clinical pilot showed that the web-delivered training was also effective at training eight novice providers to competently implement the SPA with children with ASD in a special education school. This study demonstrates that web-delivered training with virtual role-play is likely another efficient training method for implementation of behavioral procedures.

Increasing Trials Presented to Children With Autism: Using Frequency Building With Modeling and Feedback

This study evaluated the effects of a staff training package on the frequency (rate) of trial presentations to children diagnosed with autism. The training consisted of a combination of repeated timings, modeling plus frequency building, and modeling in vivo with the client plus frequency building. The experimenters implemented 20-min training sessions or frequency-building sessions with staff that used 1-min timings for trial presentation in each phase. Training resulted in a higher frequency of trials across all 3 participants in the modeling and feedback phase.

Mechanisms of Action for Empirically Supported Interventions to Reduce Adolescent Sexual Risk Behavior: A Randomized Controlled Trial

PURPOSE

Adolescents are at high risk for sexually transmitted infections, including HIV. Interventions to reduce adolescent sexual risk often have modest outcomes. Understanding of the mechanisms of program effectiveness is needed to develop stronger interventions. We used a randomized controlled trial to examine mechanisms of response to two empirically supported interventions: motivational interviewing versus behavioral skills training.

METHODS

A total of 262 adolescents (mean age = 15.89 years, standard deviation = 1.24; 34% female and 61% Latinx) were recruited from juvenile justice programs in the U.S.; all youth were randomized to motivational interviewing or behavioral skills training. Primary outcomes included (1) theory-based mechanisms (condom use attitudes, norms, self-efficacy, and intentions measured before and immediately after the interventions); and (2) risky sexual behavior (frequency of unprotected sex) and condom use measured 3 months postintervention.

RESULTS

Both interventions significantly increased positive attitudes toward condom use, self-efficacy for condom use, and intentions to use condoms post-test, with no differences by condition. Neither intervention impacted norms for condom use. Both interventions significantly decreased risky sexual behavior and increased condom use at the 3-month follow-up. The pattern of associations of Theory of Planned Behavior constructs to behavior were of similar magnitude in the two groups.

CONCLUSIONS

The results indicate common mechanisms of action for these two interventions and support the use of transdiagnostic mechanisms of treatment impact for sexual risk reduction.

Pediatric Prevention: Teaching Safety Skills

Serious threats to child safety are infrequent and unpredictable but can lead to serious injury and death. To stay safe, children must identify and avoid contact with a safety threat, escape from it, and report it to an adult so the adult can remove the threat. Research shows that active learning approaches are effective for teaching children to engage in these safety skills. Passive learning approaches are not effective. Active learning approaches require children to practice the skills in the presence of simulated threats with feedback to reinforce correct responses and promote generalization of skills to the natural environment.

The Use of Behavioral Skills Training to Teach Graph Analysis to Community Based Teachers

In this study, the experimenter trained three teachers to implement data decision rules to detect when instructional changes should be made during the visual analysis of discrete-trial percentage graphs. The experimenter used a concurrent, multiple-baseline design across participants. The experimenter trained the teachers to follow decision-making rules using instruction, modeling, rehearsal, and feedback. Following intervention, participants increased the percentage of correct data-based decisions and decreased the percentage of errors.

Improving Pre-Service Teachers' Performance Skills Through Behavioral Skills Training

In higher education, instruction that incorporates effective performance skills training is vital to equipping pre-service teachers with the tools they will use to educate children. This study evaluated the effects of behavioral skills training (BST) on performance of evidence-based practices by undergraduate pre-service special education teachers. A pre-post design was used to evaluate performance during role-play. BST sessions produced higher levels of correct performance than baseline measures across all seven participants. We discuss limitations of these results with suggestions for future research, along with recommendations for incorporating BST into university settings.

Brief Report: Using Behavioral Skills Training to Teach Skateboarding Skills to a Child with Autism Spectrum Disorder

The aim of this study was to evaluate the effects of behavioral skills training (BST) on the skateboarding skills of an 11-year-old male with autism spectrum disorder (ASD). BST was used in a multiple-probe across skills design to teach five target skateboarding skills. Imitation of an additional skill was also assessed outside of BST sessions. The overall percentage of correct skateboarding skills improved following BST. Performance gains were stable in probes across settings, and additional imitations increased across the study.

Caregivers as Interventionists and Trainers: Teaching Mands to Children with Developmental Disabilities

We evaluated the use of behavioral skills training (BST) to train caregivers to conduct procedures commonly associated with mand training. We trained two caregivers on the following procedures: (a) conducting preference assessments, (b) delivering preferred items contingent on appropriate behavior, (c) capturing and contriving motivating operations, (d) conducting probes to assess the child's current mand repertoire, (e) errorless prompting procedures using echoic prompts, (f) vocal shaping, (g) collecting data, and (h) correcting errors. We also assessed whether a trained caregiver could in turn train their spouse on these procedures. We evaluated the effects of the intervention on the frequency of child spontaneous and prompted mands. The three caregivers performed near zero percent accuracy during baseline but increased to above 80 % accuracy with training, and high performance persisted during most maintenance probes. These results were replicated for the parent who received training from their spouse. In addition, spontaneous mands were occurring more frequently than prompted mands by the end of the study. The implications of caregivers implementing mand training procedures based on Skinner's analysis of verbal behavior are discussed.

The effects of behavioral skills training on instructor and learner behavior across responses and skill sets

Behavioral skills training (BST) is effective to train staff to provide intervention to people with developmental disabilities. The purpose of this study was to assess whether: (a) prior studies demonstrating the effectiveness of BST could be systematically replicated while teaching multiple teaching instructors to implement discrete trial teaching, incidental teaching and activity schedules; (b) instructional skills that staff acquired during training on one response generalized to a variety of instructional programs, (c) positive changes in staff performance produced positive behavior change in learners; and (d) positive changes in learner behavior generalized to novel programs. BST resulted in positive behavior change across staff, learners, instructional programs, and various teaching skills. Further, staff generalized teaching skills to novel responses and learners displayed increases in correct responding for all three instructional procedures. Social validity data indicated they these staff training procedures were highly acceptable and effective. Thus, BST is an effective and acceptable staff training procedure.

The effects of in-service training alone and in-service training with feedback on data collection accuracy for direct-care staff working with individuals with intellectual disabilities

Three residential staff aged 22-38 years participated in this study which measured the accuracy of their data collection, following instruction, in-service, and in-service plus feedback. The experimenter trained them to collect data on targeted maladaptive behavior of one consumer at one time of the day. Following the in-service and the in-service plus feedback trainings, the experimenters assessed whether data collection accuracy increased for that consumer at that time and whether these improved data collection skills generalized to the other consumers and different times. The experimenter used a multiple-baseline-across-participants design to demonstrate experimental control. All three staff improved their data-collection-accuracy from instruction to in-service, and then from in-service to in-service plus feedback. Additionally, improved data collection generalized to two different consumers and two separate time periods. Future research should extend these findings of this study to measuring the effects of more accurate data collection on other functional dependent variables such as accuracy of staff implementation of behavior plans, frequency of maladaptive behavior and amount of prescribed psychotropic medications.

Implementing the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP): Teaching Assessment Techniques

The Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) is an assessment tool used with individuals diagnosed with autism spectrum disorder and other language delays (Sundberg 2008). The milestones assessment section of the VB-MAPP is used to determine an individual's current skill level. The results of the milestones assessment can be used to identify instructional goals and objectives. The current study examined the effects of behavioral skills training (BST) on the administration of the milestones assessment by two educational professionals. The BST intervention resulted in immediate increases in performance for both participants.

Improving the Conversational Skills of a College Student with Peer-Mediated Behavioral Skills Training

We used a multiple baseline design across behaviors to evaluate peer-mediated behavioral skills training to improve a complex repertoire of conversational skills of an undergraduate student diagnosed with a learning disability NOS. Following treatment, we observed a decrease in interrupting and content specificity and an increase in questioning. Treatment effects maintained with naïve peers during unstructured conversations and outcomes compared favorably with normative data on the conversational skills of three undergraduates without learning disabilities.