Bridging the gap: national virtual education programme for professionals caring for adults with intellectual and developmental disabilities at the time of COVID-19.

BACKGROUND: The COVID-19 pandemic significantly impacted the mental health of adults with intellectual and developmental disabilities (IDD). During this period of uncertainty and need for up-to-date information, various virtual training programmes demonstrated the role of tele-mentoring programmes. AIM: The aim of this paper is to describe the educational evaluation of the National Extension for Community Healthcare Outcomes - Adults with Intellectual and Developmental Disabilities (ECHO-AIDD), a programme for service providers working with adults with IDD during COVID-19. METHOD: The programme consisted of six sessions, conducted weekly, over two cycles. Each session included didactic teaching by hub team members, COVID-19 news updates, wellness check-ins and a brief mindfulness activity, followed by a 30 to 45 min case-based discussion. The hub structure had an inter-professional approach to team expertise. Those with lived experience were an integral part of the content experts' hub. Pre-, post- and follow-up evaluation data were collected. RESULTS: Care providers from health and social care sectors (n = 230) participated in the programme. High levels of engagement and satisfaction were reported. Self-efficacy ratings improved from pre- to post-, and were maintained at 8-week follow-up; improvement from pre- to post- was significant (P < 0.0001). CONCLUSION: Exposure to National ECHO-AIDD educational intervention led to improvement in perceived competencies. This study also shows the valuable role of people with lived experience in fostering adaptive expertise in learners. The outreach and scalability support the feasibility of building a national virtual community of practice for IDD service providers. Future studies should focus on studying the impact of these programmes on the health outcomes of people with IDD.

Utility of a virtual small group cognitive behaviour program for autistic children during the pandemic: evidence from a community-based implementation study.

BACKGROUND: Autistic children often experience socioemotional difficulties relating to emotion regulation and mental health problems. Supports for autistic children involve the use of adapted interventions that target emotion regulation and social skills, alongside mental health symptoms. The Secret Agent Society Small Group (SAS: SG), an adapted cognitive behavioural program, has demonstrated efficacy through lab-delivered randomized control trials. However, research is still needed on its effectiveness when delivered by publicly funded, community-based autism providers under real-world ecologically valid conditions, especially within the context of a pandemic. The COVID-19 pandemic has disrupted access to community-based supports and services for autistic children, and programs have adapted their services to online platforms. However, questions remain about the feasibility and clinical utility of evidence-based interventions and services delivered virtually in community-based settings. METHODS: The 9-week SAS: SG program was delivered virtually by seven community-based autism service providers during 2020-2021. The program included the use of computer-based games, role-playing tasks, and home missions. Caregivers completed surveys at three timepoints: pre-, post-intervention, and after a 3-month follow-up session. Surveys assessed caregivers' perception of the program's acceptability and level of satisfaction, as well as their child's social and emotional regulation skills and related mental health challenges. RESULTS: A total of 77 caregivers (94% gender identity females; Mean = 42.1 years, SD = 6.5 years) and their children (79% gender identity males; Mean = 9.9 years, SD = 1.3 years) completed the SAS: SG program. Caregivers agreed that the program was acceptable (95%) and were highly satisfied (90%). Caregivers reported significant reduction in their child's emotion reactivity from pre- to post-intervention (-1.78 (95% CI, -3.20 to -0.29), p = 0.01, d = 0.36), that continued to decrease after the 3-month booster session (-1.75 (95% CI, -3.34 to -0.16), p = 0.02, d = 0.33). Similarly, improvements in anxiety symptoms were observed (3.05 (95% CI, 0.72 to 5.36), p = 0.006, d = 0.39). CONCLUSIONS: As online delivery of interventions for autistic children remains popular past the pandemic, our findings shed light on future considerations for community-based services, including therapists and agency leaders, on how best to tailor and optimally deliver virtually based programming. TRIAL REGISTRATION: This study has been registered with ISRCTN Registry (ISRCTN98068608) on 15/09/2023. The study was retroactively registered.

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.

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.

Behavioral Skills Training for Teaching Safety Skills to Mental Health Clinicians: Protocol for a Pragmatic Randomized Control Trial.

BACKGROUND: Workplace violence is an increasingly significant topic, particularly for staff working in mental health settings. The Centre for Addiction and Mental Health (CAMH), Canada's largest mental health hospital, considers workplace safety a high priority and consequently has mandated staff safety training. For clinical staff, key components of this training are self-protection and team-control skills, which are a last resort when an individual is at an imminent risk of harm to self or others and other interventions are ineffective (eg, verbal de-escalation). For the past 20 years, CAMH's training-as-usual (TAU) has been based on a 3D approach (description, demonstration, and doing), but without any competency-based assessment. Recent staff reports indicate that the acquisition and retention of these skills may be problematic and that staff are not always confident in their ability to effectively address workplace violence. The current literature lacks studies that evaluate how staff are trained to acquire these physical skills and consequently provides no recommendations or best practice guidelines. To address these gaps described by the staff and in the literature, we have used an evidence-based approach from the field of applied behavior analysis known as behavioral skills training (BST), which requires trainees to actively execute targeted skills through instruction, modeling, practice, and feedback loop. As part of this method, competency checklists of skills are used with direct observation to determine successful mastery. OBJECTIVE: Our objectives are to evaluate the effectiveness of BST versus TAU in terms of staff confidence; their competence in self-protection and team-control physical skills; their level of mastery (predefined as 80% competence) in these skills; and their confidence, competency, and mastery at 1 month posttraining. METHODS: We are using a pragmatic randomized controlled trial design. New staff registering for their mandatory safety training are randomly assigned to sessions which are, in turn, randomly assigned to either the BST or TAU conditions. Attendees are informed and consented into the study at the beginning of training. Differences between those consenting and those not consenting in terms of role and department are tracked to flag potential biases. RESULTS: This study was internally funded and commenced in January 2021 after receiving ethics approval. As of May 2022, data collection is complete; half of the baseline, posttraining, and 1-month videotapes have been rated, and three-fourths of the interrater reliability checks have been completed. The analysis is expected to begin in late summer 2022 with results submitted for publication by fall 2022. CONCLUSIONS: The findings from this study are expected to contribute to both the medical education literature as well as to the field of applied behavioral analysis where randomized controlled trial designs are rare. More practically, the results are also expected to inform the continuing development of our institutional staff safety training program. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/39672.

Erratum: Publisher Correction to: A Telecommunication Model to Teach Facilitators to Deliver Acceptance and Commitment Training.

[This corrects the article DOI: 10.1007/s40617-021-00628-x.].

A Telecommunication Model to Teach Facilitators to Deliver Acceptance and Commitment Training.

Providing mediator training using a telecommunication format increases access to training by reducing geographical and financial barriers, while maintaining or increasing efficiency. Limited research has implemented this format to train facilitators in acceptance and commitment training (ACT), an empirically supported intervention. The aim of this research was to examine the efficacy of behavioural skills training via telecommunication for training novice facilitators to provide ACT to caregivers of individuals with neurodevelopmental disabilities. This two-part study involved concurrent multiple-baseline designs, each across 4 participants. Quantitative data on fidelity and confidence were collected at baseline, post-training, and at 1-month follow-up. The results from this study provide preliminary support for the use of behavioural skills training via telecommunication to train ACT facilitators. Increasing the number of competently trained facilitators will help build capacity to increase access to ACT across geographical regions. Supplementary Information: The online version contains supplementary material available at 10.1007/s40617-021-00628-x.

Predictors of worker mental health in intellectual disability services during COVID-19.

BACKGROUND: Workers supporting adults with intellectual disabilities experience significant stress in their essential role during COVID-19. The purpose of this study was to describe the experience of these workers and determine predictors of emotional distress. METHODS: Eight hundred and thirty-eight workers supporting adults with intellectual disabilities completed an online survey about their work during COVID-19 and their mental health in July 2020. RESULTS: One in four workers reported moderate to severe emotional distress. Being older and more experienced, having counselling services available through one's agency, and engaging in regular exercise or hobbies outside work were associated with less distress. Workers who reported increased stress in the workplace, stigma towards their families because of their job, personal fears about spreading COVID-19, and receipt of medications for mental health conditions or therapy reported greater distress. CONCLUSIONS: More attention is needed to address the mental health of workers supporting adults with intellectual disabilities as they continue their essential work during the pandemic.

Evaluation of a caregiver training program to teach help-seeking behavior to children with autism spectrum disorder.

Alarmingly, nearly half of children with autism spectrum disorder (ASD) engage in behaviour that causes separation from caregivers. More than half of these children go missing for a concerning duration of time and/or enter into dangerous situations. Caregivers often do not feel prepared to address these serious concerns. This study evaluated the effectiveness of behaviour skills training (BST) for teaching caregivers how to also use BST in conjunction with a tactile prompt to teach their children with ASD help-seeking behaviour. Participants included five caregiver-child dyads. Children were diagnosed with ASD and were between the ages of 5-10 years. A non-concurrent multiple probe design across three dyads with a concurrent replication across an additional two dyads was used to evaluate whether the BST procedure increased child safety responses when separated from caregivers in store settings. Child behaviours were measured using a 3-step help-seeking behaviour chain: (1) calling out for their caregiver in a louder than conversational voice, (2) locating a store employee, and (3) informing the employee that they were lost. All children met mastery criteria (a safety response score of 3 across two consecutive trials), and four of the caregivers were able to successfully fade the tactile prompting device in the natural environment. This study contributes to the limited empirical research on caregiver implemented safety training using BST to teach help-seeking behaviour to children with ASD.

Comparison of two TAGteach error-correction procedures to teach beginner yoga poses to adults.

Teaching with acoustical guidance involves auditory feedback (e.g., a click sound when a desired behavior occurs) as part of a multicomponent intervention known as TAGteach. TAGteach has been found to improve performance in sport, dance, surgical technique, and walking. We compared the efficacy and efficiency of the standard TAGteach error-correction procedure and a modified TAGteach error-correction procedure to teach 4 novice adult yoga practitioners beginner yoga poses. Both error-correction procedures were effective for all participants; however, the relative efficiency of these error-correction procedures was unclear. Results are discussed in terms of limitations and considerations for future research.

A randomized waitlist-controlled trial of cognitive behavior therapy to improve emotion regulation in children with autism.

BACKGROUND: Mental health problems are common among individuals with autism spectrum disorder (ASD), and difficulties with emotion regulation processes may underlie these issues. Cognitive behavior therapy (CBT) is considered an efficacious treatment for anxiety in children with ASD. Additional research is needed to examine the efficacy of a transdiagnostic treatment approach, whereby the same treatment can be applied to multiple emotional problems, beyond solely anxiety. The purpose of the present study was to examine the efficacy of a manualized and individually delivered 10-session, transdiagnostic CBT intervention, aimed at improving emotion regulation and mental health difficulties in children with ASD. METHODS: Sixty-eight children (M age = 9.75, SD = 1.27) and their parents participated in the study, randomly allocated to either a treatment immediate (n = 35) or waitlist control condition (n = 33) (ISRCTN #67079741). Parent-, child-, and clinician-reported measures of emotion regulation and mental health were administered at baseline, postintervention/postwaitlist, and at 10-week follow-up. RESULTS: Children in the treatment immediate condition demonstrated significant improvements on measures of emotion regulation (i.e., emotionality, emotion regulation abilities with social skills) and aspects of psychopathology (i.e., a composite measure of internalizing and externalizing symptoms, adaptive behaviors) compared to those in the waitlist control condition. Treatment gains were maintained at follow-up. CONCLUSIONS: This study is the first transdiagnostic CBT efficacy trial for children with ASD. Additional investigations are needed to further establish its relative efficacy compared to more traditional models of CBT for children with ASD and other neurodevelopmental conditions.

An Evaluation of Behavioral Skills Training for Teaching Caregivers How to Support Social Skill Development in Their Child with Autism Spectrum Disorder.

Limited research has explored how to best train caregivers to support their child with autism spectrum disorder (ASD) despite caregivers being well suited to promote generalization and maintenance of their child's skills in the natural environment. Children with ASD have been shown to benefit from social skill training, which is not always conducted in the natural context. This research examined the efficacy of behavioral skills training (BST) with, and without in situ training (IST), for teaching caregivers how to also use BST to support their child's context-specific social skills. Although caregivers met mastery criterion within BST sessions, their skills did not generalize to the natural environment until IST was introduced. The implications of the findings are discussed.

Brief Report of Preliminary Outcomes of an Emotion Regulation Intervention for Children with Autism Spectrum Disorder.

Children with autism spectrum disorder (ASD) often present with comorbid psychopathology including problems with emotion regulation. The goal of the present research was to investigate the feasibility of a multicomponent manualized cognitive behavior therapy treatment program for improving emotion regulation in youth with ASD 8-12 years of age. Thirteen males and their parents participated in the intervention, reporting high satisfaction with the activities and program overall, and attending all sessions. Preliminary outcomes regarding emotion regulation and psychopathology, and feasibility of the intervention, are summarized and discussed.

A systematic literature review of emotion regulation measurement in individuals with autism spectrum disorder.

Emotion regulation (ER) difficulties are a potential common factor underlying the presentation of multiple emotional and behavioral problems in individuals with Autism Spectrum Disorder (ASD). To provide an overview of how ER has been studied in individuals with ASD, we conducted a systematic review of the past 20 years of ER research in the ASD population, using established keywords from the most comprehensive ER literature review of the typically developing population to date. Out of an initial sampling of 305 studies, 32 were eligible for review. We examined the types of methods (self-report, informant report, naturalistic observation/ behavior coding, physiological, and open-ended) and the ER constructs based on Gross and Thompson's modal model (situation selection, situation modification, attention deployment, cognitive change, and response modulation). Studies most often assessed ER using one type of method and from a unidimensional perspective. Across the 32 studies, we documented the types of measures used and found that 38% of studies used self-report, 44% included an informant report measure, 31% included at least one naturalistic observation/behavior coding measure, 13% included at least one physiological measure, and 13% included at least one open-ended measure. Only 25% of studies used more than one method of measurement. The findings of the current review provide the field with an in-depth analysis of various ER measures and how each measure taps into an ER framework. Future research can use this model to examine ER in a multicomponent way and through multiple methods.

The history of behavior analysis in manitoba: a sparsely populated canadian province with an international influence on behavior analysis.

This article examines the convergence of factors that led to behavior analysis taking root, flourishing, and bearing fruit in a prairie province of Canada. In the latter half of the 1960s, Garry Martin and Joseph Pear began teaching behavior-analytic courses at the University of Manitoba. They and their students then initiated behavioral treatment and research programs at the Manitoba Developmental Center and St.Amant, the two main residential facilities for persons with intellectual disabilities and autism. Since that time, behavior analysis in Manitoba has flourished, and the knowledge and skills gained have been shared with other behavior analysts throughout the world through conferences, articles, and books. Behavior-analytic books by authors who live and work in Manitoba have been translated into eight languages. Moreover, University of Manitoba graduates in behavior analysis have helped to spread knowledge of behavior analysis throughout the world, and a number have achieved highly influential positions and widespread recognition within the discipline.

Limitations in 4-year-old children's sensitivity to the spacing among facial features.

Four-year-olds' sensitivity to differences among faces in the spacing of features was tested under 4 task conditions: judging distinctiveness when the external contour was visible and when it was occluded, simultaneous match-to-sample, and recognizing the face of a friend. In each task, the foil differed only in the spacing of features, and spacing alterations were within normal limits. Children performed at chance levels in all but 1 task-match-to-sample, and in that task, only 10 of 18 children were correct on more than 50% of the trials. Sensitivity to the spacing of facial features in identity and distinctiveness tasks is very weak at 4 years of age-at least when the changes do not exceed +/-2.5 SD of normal variability.

Predicting Optimal Preference Assessment Methods for Individuals with Developmental Disabilities.

The single-stimulus (SS) preference assessment procedure has been described as more appropriate than the paired stimulus (PS) procedure for "lower functioning" individuals, but this guideline's vagueness limits its usefulness. We administered the SS and PS preference assessment procedures with food items to seven individuals with severe or profound developmental disabilities who scored at level 2 of the Assessment of Basic Learning Abilities (ABLA) and seven who scored at ABLA level 3. Thirteen of the 14 participants also received these assessments (PS and SS), with non-food items. The two procedures were about equally effective for both groups, and with both types of stimuli, although the PS procedure produced more refined preference hierarchies. Most participants showed moderate to high correlations in preference scores between the two procedures for both food and non-food items. These results suggest that, for individuals who score at either ABLA level 2 or ABLA level 3, the SS and the PS procedures are equally likely to identify preferred stimuli.