Using external memory aids to increase room finding by older adults with dementia.

When nursing home residents with dementia are unable to locate their own rooms, it often creates problems for staff and other residents. The impact of placing two external memory aids outside participants' bedrooms was evaluated by using a multiple-baseline design experiment. Three female special care unit (SCU) residents with severe Alzheimer's disease (MMSE = 5.7) participated in the study. Results showed that a combination of a portrait-type photograph of the participant as a young adult and a sign stating the resident's name increased room finding by over 50 percent with all three participants. Room finding stabilized at 100 percent accuracy for all participants within a few days of implementing the environmental intervention.

Keeping the beat: use of rhythmic music during exercise activities for the elderly with dementia.

Involving people with dementia in group exercise activities often presents a challenge. The effects of a recorded instrumental musical accompaniment was evaluated on participation in a series of 14 exercise activities with a group of nursing home residents with dementia. All exercise sessions, specifically designed by physical therapists for older adults, were lead by an activity aide and consisted of a series of seated exercises. Direct observations of resident behavior were conducted over a 25-week period in a reversal experimental design. Results showed increased levels of participation during the experimental condition observations where rhythmic music accompanied the exercise activities. The music intervention was most successful on those generally most willing to participate in social activities.

Using public feedback to increase contributions to a multipurpose senior center.

Multipurpose senior centers are expanding their services to meet the demands of a growing population. Unfortunately, federal agencies have not matched this expansion with monetary support. Many senior centers hold fund-raisers to supplement their budgets, but the impact of these projects is rarely evaluated. This study assessed the effectiveness of a public posting strategy designed to increase donations to an ongoing fund-raiser for a multipurpose senior center. The fund-raiser, "Coupons for Caring," consisted of senior volunteers clipping grocery coupons from newspapers, sorting them, and attaching them to their respective products in local grocery stores. Grocery store customers were given the option of donating the coupons to the senior center or redeeming them when they purchased the products to which the coupons were attached. In the experimental condition, signs were posted that included visual and written instructions, feedback on the value of coupons donated by customers the previous week, and feedback on the overall amount of money donated to the senior center. The signs were posted near each cashier stand and at the front entrances of the grocery stores in a multiple baseline across grocery stores. The percentage of coupons donated to the senior center increased at each store after the signs were posted.

Behavior change in the funny papers: feedback to cartoonists on safety belt use.

A multiple baseline across 8 nationally syndicated cartoonists evaluated the effects of personal advocacy letters encouraging presentations of a specific prevention message--the depiction of safety belt use in comic strips showing motor vehicle occupants. During baseline these cartoonists depicted safety belt use in only 15% (6 of 41) of their strips with occupied vehicles, but following receipt of a personal letter requesting safety belt use 41% (42 of 102) of their strips depicted safety belt use. Four cartoonists showed clear and immediate increases in depiction of safety belt use, 2 demonstrated delayed and somewhat less consistent belt use, and 2 cartoonists showed no change. The approach and results are discussed with regard to advocacy efforts intended to influence presentation of prevention messages in the media.

Prompted voiding to reduce incontinence in community-dwelling older adults.

In-home caregivers were taught to implement a prompted voiding procedure with 2 older adults with cognitive impairments and urinary incontinence. Results suggested that the procedures can be implemented by family caregivers, and the intervention reduced incontinence for both participants.

Community applications of instructional technology: training low-income proctors.

A community education system might be most effectively implemented in low-income communities if it were deliverable by neighborhood residents. A proctor training manual, designed to teach neighborhood residents how to administer standardized learning units to their peers, was analyzed in two experiments. The results of Experiment I showed that the percentage of occurrence of proctor behaviors increased after completion of the manual. Supplementary data suggest that specified proctor behaviors generalize to actual instructional situations. The results of Experiment II showed that the percentage of occurrence of trainee behaviors was higher when instructional packages were administered by trained proctors than when administered by untrained proctors. This study demonstrates an effective procedure for training low-income community residents to serve as proctors for a community education system.

Some promising dimensions for behavioral community technology.

In recent years, the search for effective and replicable approaches to planned change in communities has escalated. Applied behavior analysts have participated in these efforts to remedy existing community problems and to increase the capacities of community residents to meet their goals. Examples of behavioral technologies for community settings are described and their advantages are noted. Criteria for more contextually appropriate community technologies are suggested and strategies for developing behavioral methods according to these criteria are described. This paper outlines some promising dimensions for behavioral community technology and discusses several possible limitations to a behavioral approach to addressing societal problems.

Reducing risk of pressure sores: effects of watch prompts and alarm avoidance on wheelchair push-ups.

People who use wheelchairs are at risk for developing pressure sores. Regular pressure relief, in the form of a wheelchair push-up, is one way to reduce the likelihood of pressure sores. We examined the effects of antecedent (i.e., instructions, audible prompts) and consequent (i.e., alarm avoidance) events on wheelchair push-ups, using a multiple baseline analysis with 2 participants with spina bifida. Results suggest that the combined procedure was more effective than either antecedent or consequent events alone, and there is some evidence suggesting maintenance of effects over time.

Home access modifications: effects on community visits by people with physical disabilities.

We examined the effects of access modifications to home entrances of people with physical disabilities on their reported community outings. An interrupted time-series design was used, in which the introduction of ramps was staggered across the homes of 6 people with moderate to severe mobility impairments. Four participants reported increases in weekly outings following installation of ramps at their entrances, and 2 reported a small decrease. These findings suggest that reducing the response requirements of access to and from the residence of people with mobility impairments may increase community visits, but may be insufficient given other environmental barriers in the community.

Behavior analysis and public policy.

The Task Force on Public Policy was created to examine ways for behavior analysts to be more functional citizen scientists in the policymaking arena. This report informs readers about the contexts and processes of policymaking; and it outlines issues regarding the roles of behavior analysts in crating policy-relevant conceptual analyses, generating research data, and communicating policy-relevant information. We also discuss a possible role for the professional association in enhancing analysis, research, and advocacy on policies relevant to the public interest.

Using video simulated presence to reduce resistance to care and increase participation of adults with dementia.

BACKGROUND: Cognitive and functional decline in dementia generally impairs performance of basic care activities. Staff assistance during these activities frequently results in confusion, anxiety, and distress, expressed through resistance to care (RTC). METHODS: A single-system ABA withdrawal design (n = 1) evaluated the effect of video-simulated presence (VSP) for decreasing RTC and increasing participation. A family member pre-recorded videos for use during episodes of RTC, in which the family member spoke directly to the participant to encourage participation. RESULTS: Introduction of the VSP significantly reduced RTC during the basic care tasks of feeding and talking medication. This effect was reversed when the intervention was withdrawn. Participation increased following VSP, demonstrating clear trends toward clinical significance. CONCLUSIONS: This person-centered intervention, based on VSP of a family member, provides encouraging results for reducing RTC and increasing participation of adults with dementia in basic care tasks.

Enhancing leadership skills for community self-help organizations through behavioral instruction.

Group members with skills to lead effective meetings are valuable resources of any community organization. The effects of a behaviorally based textbook and training procedures designed to teach members of community self-help groups to chair effective meetings were analyzed. Measures were collected during regularly scheduled meetings on chairperson performance, member participation, and the closure of discussion topics. The results showed that the use of specified chairperson activities increased after training for each of two chairperson trainees. Further, outcome data suggest that more decisions were made. These findings suggest that the chairperson training procedures may enhance the leadership and decision-making resources of community self-help groups.

A contextual-behavioral model of empowerment: case studies involving people with physical disabilities.

When people with disabilities, ethnic minorities, older adults, women, and others lack power, they usually experience adverse conditions disproportionate to other members of society. Empowerment--the process by which people gain some control over valued events, outcomes, and resources--is an important construct for understanding and improving the lives of people of marginal status. This manuscript presents a contextual-behavioral model of empowerment and its application in collaborative research with people with physical disabilities. The eight case studies illustrate 18 tactics for promoting empowerment that flow from the model. The case studies show the use of different combinations of empowerment tactics in a variety of contexts: (a) setting improvement agendas from the perspective of people with disabilities, (b) enforcing ordinances that preserve access to parking spaces designated for people with disabilities, (c) enabling access to homes through housing modifications, (d) enhancing support available through mutual-aid groups, (e) developing skills for recruiting mentors, (f) promoting self-directed behavior change with personal and health concerns, (g) enhancing skills for personal self-advocacy, and (h) building the capacities of groups of people with disabilities for systems advocacy. Finally, we discuss issues that may contribute to research and action related to empowerment.