Community Participation of Individuals with Mental Illnesses in Rural Areas: Stakeholder Perspectives on Barriers and Facilitators.

Community inclusion and participation are social determinants of physical and mental health. This study examines activity preferences, barriers to engagement, and potential strategies for facilitating community participation for individuals with serious mental illness living in rural communities. Data for this qualitative study were collected in a series of focus groups with a stakeholders in rural Pennsylvania. Written responses to questions on activities, barriers, facilitators, and solutions were analyzed by members of the research team. The activities that are important to our participants included both those readily accessible in rural areas and those only accessible in more urban areas. Many of the barriers identified aligned with prior research (e.g., poverty, community mobility issues). A number of novel and feasible solutions to overcome barriers were provided at the policy, program, and practice levels, some of which that can be implemented immediately, to increase participation, and improve overall health of people with mental illnesses.

A Survey of Why and How Clinicians Change Reinforcers during Teaching Sessions.

Preference assessments are used to make data-based decisions about which stimuli to use as reinforcers but they can be challenging to conduct frequently enough to avoid problems related to momentary shifts in preference and reinforcer efficacy. It remains unclear whether, why, and how clinicians change reinforcers on a momentary basis. Therefore, this study aimed to determine common reasons for, and methods of, changing reinforcers in practice. Most respondents indicated that they often change reinforcers during a session, do so when the client mands for or attends to different stimuli or refuses the current stimulus, and identify the new reinforcer based on recent client behaviors (e.g., mands) or by providing an informal choice between stimuli. Responses did not vary meaningfully based on respondent credentials, client characteristics, or service goals. Implications for clinical practice as well as future research on methods of momentary preference assessment and reinforcer identification are discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s40617-023-00847-4.

Paying for Supervision: Barriers, Solutions, and Opportunities.

In some situations, those requiring supervision to meet Behavior Analyst Certification Board supervised fieldwork requirements, maintain certification, or get assistance with a difficult case or ethical dilemma may need to contract with a qualified supervisor and pay them directly. Although it is not considered to be a multiple relationship, the financial component does carry an inherent conflict of interest, which can create barriers to effective and appropriate supervision. In this article we propose a list of barriers that may arise in this particular supervisory relationship and potential solutions to manage each one, with a particular focus on supervised independent fieldwork. We also discuss unique learning opportunities that may arise from this situation that may be beneficial to both the trainee and supervisor.

Participation in arts and culture among individuals with serious mental illnesses and its relationship to quality of life and recovery.

OBJECTIVE: Engagement in arts and cultural activities is valued and yields positive outcomes but may be understudied in populations with serious mental illness (SMI). Our aims are to evaluate the extent to which individuals with SMI deem participation areas related to arts and culture (e.g., going to a theater) to be important, and if important, how often they are being done and if it is enough in comparison to a nonSMI sample. METHODS: We conducted analyses using a sample of 1,120 individuals with SMI from nine research studies between 2008 and 2016 and a sample of 300 individuals without SMI that were part of the Truven Health Analytics PULSE survey. All participants completed a survey containing questions related community participation. Analyses were conducted using independent samples t tests, followed by analysis of variances, and chi-square tests. RESULTS: The results indicate that adults with SMI are as, or more interested in arts and cultural activities as adults in the general population, but do not participate in those areas as much as they would like in comparison. We also found that, as with the general population, participation in these areas is positively associated with quality of life and to a lesser degree, recovery. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Engagement in arts and culture activities may be an overlooked compared to other areas of participation, such as employment. Psychiatric rehabilitation practitioners may need to pay greater attention to areas related to art appreciation, rather than just art production. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

New (old) perspectives on self-injurious and aggressive biting.

Functional analyses and treatments of self-injurious behavior and aggression have shown that such behavior is often operant. In this paper, we will revisit evidence that a subset of self-injurious and aggressive biting may be controlled primarily by antecedent events and may have phylogenetic origins. We propose that there is a research gap of more than four decades, if one considers the wealth of basic research on biting that occurred prior to 1977. To our knowledge, that body of basic research was never fully translated or directly applied within behavior analysis. It is known that organisms (including humans) sometimes bite in the presence of aversive events (broadly defined as the presentation of aversive stimuli or the removal of reinforcers). Thus, the variables controlling biting in the context of behavioral assessment and treatment require further analysis.

Further evaluation of functional analysis screening methods in early autism intervention.

A goal of some functional analysis (FA) variations is to reduce assessment time while still maintaining efficacy. This may be especially important when conducting FAs in early intervention programs, where time is a crucial commodity. To that end, we evaluated a model for using the results of the no-interaction condition as a screening for behavioral function and to guide selection of FA test conditions with 20 participants (22 assessments) aged 3 to 7 years old. We used the no-interaction condition to develop hypotheses for both automatic reinforcement and socially mediated reinforcement. The outcome of the no-interaction condition guided the selection of test conditions for the remainder of the FA. We also incorporated methods from prior FA studies (e.g., divided attention) to modify the test conditions. We obtained differentiated results in 91% of assessments, all within 70 min and, as such, extended evidence that an FA can be completed in little time without sacrificing efficacy.

Leveraging applied behavior analysis research and practice in the service of public health.

Human behavior plays a central role in all domains of public health. Applied behavior analysis (ABA) research and practice can contribute to public health solutions that directly address human behavior. In this paper, we describe the field of public health, identify points of interaction between public health and ABA, summarize what ABA research has already contributed, and provide several recommendations for how ABA research and practice could continue to promote public health outcomes. A clearer focus on behavior and widespread adoption of research designs and interventions informed by the ABA literature could lead to better public health outcomes. Reciprocally, better integration of public health goals and strategies into ABA research, harnessing of technology, and more collaboration would help diversify and disseminate our applied science and could yield more effective and scalable interventions to prevent and treat public health problems.

Comparing the results of one-session, two-session, and three-session MSWO preference assessments.

The multiple-stimulus-without-replacement (MSWO) preference assessment is commonly used in behavior-analytic research and practice. As originally published, the MSWO included 5 sessions in an effort to confirm stimulus preferences. Subsequent researchers have evaluated the validity of MSWO outcomes when the assessment is abbreviated. Generally, valid outcomes have been noted for 3-session MSWOs (that is, the outcomes match those of the 5-session version), while validity outcomes for 1- or 2-session MSWOs have varied across studies. The current study utilized data from 157 MSWO preference assessments conducted in previously published research with 49 total participants and analyzed the extent to which 1-session or 2-session variations of those assessments would have yielded similar outcomes as a 3-session assessment. Results indicate that the hierarchies produced by both abbreviated formats were strongly correlated with those produced by a 3-session assessment. However, neither 1- nor 2-session MSWOs reliably identified the same highest-preferred stimuli as a 3-session MSWO.

Relative preferences for edible and leisure stimuli in children with autism: A replication in Italy.

Several studies have found that edible items tend to displace leisure items in multiple-stimulus preference assessments for individuals with developmental disabilities. One recent study (Conine & Vollmer, 2019) included screen-based technology devices in assessments and found that food items were less likely to displace leisure items and in some cases leisure items totally displaced edible items. The purpose of our study was to conduct a replication of Conine and Vollmer in Italy to evaluate cultural differences in food and leisure preferences. Results of our study were similar: For 44% of participants, at least one leisure item ranked above all edible items and leisure items displaced all edible items for 28% of participants. Participants in the present study showed a higher preference for leisure items or toys that were not screen-based technology devices, suggesting there may be cultural variation in the types of leisure items that are preferred.

Behavior Change, Egg Consumption, and Child Nutrition: A Cluster Randomized Controlled Trial.

BACKGROUND AND OBJECTIVES: Malnutrition is a significant contributor to child morbidity and mortality globally. Egg consumption has been associated with improved child nutrition yet is rare in rural, resource-poor settings. We test the effects of a culturally tailored behavior change intervention to increase child egg consumption. METHODS: A 3-arm cluster randomized controlled trial was conducted in rural Burkina Faso with 260 mother-child dyads. Children aged 4 to 17 months from 18 villages were included; those with reported history of malnutrition or egg allergy were excluded. Each child in the full intervention arm received 4 chickens, and mothers received the 10-month behavior change package. Participants in the partial intervention arm received only the behavior change package. RESULTS: In this analysis of 250 children, the full (ß = 4.3; P = 6.6 × 10-12) and the partial (ß = 1.0; P = .02) interventions significantly increased egg consumption. The full intervention also significantly increased poultry production (ß = 11.6; 95% confidence interval 8.3-15; P = 1.1 × 10-5) and women's decision-making about eggs (ß = .66; P = .02), and significantly decreased wasting (ß = .58; P = .03) and underweight (ß = .47; P = .02). CONCLUSIONS: The culturally tailored behavior change package significantly increased child egg consumption. When coupled with the gift of chickens, the behavior change intervention yielded a greater increase in egg consumption and significantly reduced wasting and underweight. Behavior change strategies to increase egg consumption should be considered among nutrition and health programs in resource-poor settings where poultry is available.