Maintaining Family Engagement During Home Visitor Turnover: a Mixed Methods Study of Best Practices.

Evidence-based home visiting services (EBHV) are available in states and localities nationwide through the federally-funded Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. Nevertheless, the anticipated benefits of EBHV, such as improved child developmental outcomes and increased positive parenting practices, may be undermined by the fact that most families withdraw from services earlier than the model developers planned. Prior studies have linked family attrition with staff turnover. The current study used a mixed methods design to investigate the conditions under which families remained active in the home visiting program after their assigned home visitor resigned. Coincidence Analysis revealed that giving families advance notice (at least 1 month) prior to the home visitors' upcoming resignation or developing a strong positive working alliance with the inheriting home visitor appears to independently make a difference for ongoing family engagement at 3 and 6 months following a staff transition. These findings suggest that emphasizing how staff turnover is managed may mitigate the risk of family withdrawal during these transitions.

The beginning of a friendship: Teaching individuals with autism to identify shared interests.

Individuals with conversation skill deficits often have difficulties discriminating cues of interest and uninterest from their conversation partner(s). We used behavioral skills training (BST) to teach 3 individuals with autism spectrum disorder to converse about the conversation partner's topics of interest, initiate strategic preferred topics to identify shared interests after indices of uninterest, and end the conversation. We assessed generality of each skill across conversation partners and ratings of social acceptability. We replicated previous research on BST producing robust increases in following the conversation, shifting the topic of conversation, and ending the conversation. In addition, all participants learned to categorize shared interests. We observed overall high levels of generality across following, shifting, and ending the conversation with all conversation partners. However, for 2 out of the 3 participants the inclusion of rules was necessary to promote the generality of the intraverbal categorization response. We discuss the implication of these findings for clinical practice and future research.

Descriptive assessment of conversational skills: Towards benchmarks for young adults with social deficits.

Descriptive assessments are necessary to identify social norms and establish a foundation for experimental analysis. Much of the social skills intervention literature involves goals that have been selected through interviews and direct observation of behavior without a reference to desired outcomes. The purpose of the current study was to extend research on descriptive assessments of conversations by including additional measures and examining conversational behavior across contexts. We conducted a descriptive assessment of social skills exhibited by 16 neurotypical young adults. Participants had 10-min conversations in groups and 1-on-1 with friends and novel individuals. We then assessed variability within and across participants on a wide array of relevant measures. Throughout the conversations, participants shared the conversation time equally, spent most of the conversation time making on-topic comments, and gazed at their conversation partner more frequently while listening than while speaking. These descriptive data extend current research, inform future experimental analyses, and may guide clinical decisions.

Remote teaching of publication-quality, single-case graphs in Microsoft Excel.

Microsoft Excel is ubiquitous, cost-effective, and can be used to create publication-quality single-case design graphs. We systematically replicated the GraphPad Prism video tutorial by Mitteer et al. (2018) to teach 24 master's students to create multiple-baseline graphs using Excel 2016. Students' mean accuracy on the multiple-baseline graph was 25% in pretraining, 86% with the video tutorial, and 96% with the review checklist. Next, students used the same video tutorial to create multielement and reversal graphs. Students' mean accuracy on the multielement graph was 93% with video tutorial and 94% with review checklist, and accuracy on the reversal graph was 82% with video tutorial and 94% with review checklist. Students reported moderate to high satisfaction with both training components. The results support scientist-practitioners using the video tutorial and review checklists to create three common graphs using Excel 2016, Excel 2019, and Excel Office 365.

Nuclear translocation ability of Lipin differentially affects gene expression and survival in fed and fasting Drosophila.

Lipins are eukaryotic proteins with functions in lipid synthesis and the homeostatic control of energy balance. They execute these functions by acting as phosphatidate phosphatase enzymes in the cytoplasm and by changing gene expression after translocation into the cell nucleus, in particular under fasting conditions. Here, we asked whether nuclear translocation and the enzymatic activity of Drosophila Lipin serve essential functions and how gene expression changes, under both fed and fasting conditions, when nuclear translocation is impaired. To address these questions, we created a Lipin null mutant, a mutant expressing Lipin lacking a nuclear localization signal (LipinΔNLS ), and a mutant expressing enzymatically dead Lipin. Our data support the conclusion that the enzymatic but not nuclear gene regulatory activity of Lipin is essential for survival. Notably, adult LipinΔNLS flies were not only viable but also exhibited improved life expectancy. In contrast, they were highly susceptible to starvation. Both the improved life expectancy in the fed state and the decreased survival in the fasting state correlated with changes in metabolic gene expression. Moreover, increased life expectancy of fed flies was associated with a decreased metabolic rate. Interestingly, in addition to metabolic genes, genes involved in feeding behavior and the immune response were misregulated in LipinΔNLS flies. Altogether, our data suggest that the nuclear activity of Lipin influences the genomic response to nutrient availability with effects on life expectancy and starvation resistance. Thus, nutritional or therapeutic approaches that aim at lowering nuclear translocation of lipins in humans may be worth exploring.

A randomized clinical trial of a virtual-training program for teaching applied-behavior-analysis skills to parents of children with autism spectrum disorder.

Parents play an important role in the treatment of their children's symptoms of autism spectrum disorder (ASD); thus, developing effective, efficient, socially acceptable, and accessible procedures for training parents to implement applied-behavior-analysis (ABA) interventions is critically important. One potential approach involves delivering training via a virtual private network (VPN) over the internet (Fisher et al., 2014). In this study, we conducted a randomized clinical trial to evaluate a virtual parent-training program with e-learning modules and scripted role-play via a VPN. We evaluated parent implementation of ABA skills using direct-observation measures in structured-work and play-based training contexts. Parents in the treatment group showed large, statistically significant improvements on all dependent measures; those in the waitlist-control group did not. Parents rated the training as highly socially acceptable. Results add to the growing literature on the efficacy and acceptability of virtually delivered training in ABA.

Improving accepting and giving compliments with individuals with developmental disabilities.

Individuals with developmental disabilities, such as autism spectrum disorder, typically exhibit conversation skill deficits, with two prevailing deficits including giving and accepting compliments. The current study used an individualized approach to assess and teach accepting and giving compliments specific to performance, possession, and appearance with three adolescents and young adults with developmental disabilities. We taught these skills using behavioral skills training and prompting during conversations utilizing a multiple-baseline design across participants. We also observed generalization and treatment extension of the participants' skills in conversations with adults not associated with teaching and in the absence of any teaching procedures. The results support the efficacy of the procedures used toward improving giving and accepting compliments within the context of a conversation. We discuss considerations to improve the social acceptability of and refinements to the teaching procedures and acquired skills.

Evaluating the effects of physical reactions on aggression via concurrent-operant analyses.

Under naturally occurring conditions, the individual who is the target of aggression is likely to physically react to evade the aggressor and avoid physical harm. Like other forms of attention that occur following problem behavior, physical reactions may maintain problem behavior. However, evaluating the effects of physical reactions is complicated by issues related to therapists' ability to consistently and safely control their reactions, which may prove difficult to achieve in functional analyses. We evaluated the utility of a concurrent-operant analysis to test behavioral sensitivity to physical reactions. The results suggest that the concurrent-operant analysis may be useful when therapists cannot consistently refrain from responding contingent on problem behavior in the control condition of a more typical functional analysis.

Evaluating motion detection to score sleep disturbance for children: A translational approach to developing a measurement system.

Information obtained via direct observation of children's sleep disturbance throughout the night in their home can guide the assessment and treatment process, but watching live or via recorded video might be impractical in terms of time expenditures. In Experiment 1, we assessed the accuracy and reliability of a motion-detection camera with human motor movements. In Experiment 2, we tested the system's generality by using it to obtain in-home measures of sleep disturbance for three children with autism spectrum disorder and compared the accuracy to a continuous measurement system. We also measured scoring efficiency and assessed parents' acceptability of the camera. Results provide preliminary support for motion detection in measuring sleep disturbance, but further evaluation of motion detection to improve accuracy is warranted.

Evaluation of the accuracy, reliability, efficiency, and acceptability of fast forwarding to score problem behavior.

Technological advances have allowed professionals to obtain extended recordings of caregiver-client interactions in natural settings, but scoring recorded video at normal speed to identify instances of low-rate problem behavior is impractical in terms of scoring time. Fast forwarding is a continuous measurement system in which all seconds of an observation are viewed at a speed faster than normal. In Study 1, we evaluated whether three groups of five observers could discriminate problem behavior at three fast-forwarding speeds across 10-min observations. We analyzed the efficiency of using fast forwarding compared to continuous scoring, and interobserver agreement across the fast-forwarding speeds. In Study 2, we compared the accuracy, efficiency, and social acceptability of fast forwarding (3.5x) and momentary time sampling (3.5 s) across 90-min observations. Results support the use of 3.5x fast forwarding as a viable measurement system of improving the practicality of scoring problem behavior from video.

Toward meaningful outcomes in teaching conversation and greeting skills with individuals with autism spectrum disorder.

We identified greeting and conversation deficits based on a parent interview and semistructured direct assessment for one child and two adolescents with autism spectrum disorder. We taught the greeting and conversation skills using behavioral skills training and within-session corrective feedback. A multiple baseline across conversation and greeting skills demonstrated experimental control over the effects of the teaching on acquisition and generalization to novel adults. We also conducted embedded reversals to assess maintenance of the acquired skills. Teaching produced robust acquisition, generalization, maintenance, and treatment extension for 15 of the 16 targeted skills across participants. Participant and parent reports indicated high levels of social validity for the intervention and outcomes. The results support individualized assessment and intervention for improving greeting and conversation skills during unscripted interactions, which are requisite for more extended and complex social interactions.

Role of patient adherence in maintenance of results after manipulative therapy for lymphedema.

Lymphedema (LE) is a chronic side effect of cancer therapy occurring when the axilla or groin is extensively treated; subsequently, the affected limb may swell severely. Early therapy may halt the process. We previously published a prospective trial of complete decongestive therapy (CDT) for LE, but some of our data are concerning. Despite good results after initial therapy, girth and volume returned to baseline by the 12-month follow-up in many cases. Thus, although the value of the active therapy is well established, many patients lose that advantage when they are responsible for their own care. CDT consists of treatment and maintenance phases. The former (phase I) includes (1) manual lymphatic drainage (MLD), (2) skin and nail care, (3) compression bandaging, and (4) therapeutic exercise. During active therapy, the patient is seen for 60- to 90-minute treatment sessions daily, 5 days per week. When girth and volume measurements plateau, the patient begins the maintenance phase (phase II). This is self-care, and includes all components of phase I except MLD; however, patients are responsible for their own bandaging. In an IRB-approved retrospective protocol, we assessed the relationship between patients' self-reported compliance with therapy and results posttreatment. Eleven patients underwent CDT and have been seen in follow-up. Patients reporting compliance had significantly better results than those reporting noncompliance (rank sum p= .042). Patient adherence is crucial to maintenance of relief after therapeutic intervention for LE. Further study is ongoing by our team regarding correlates of patient adherence, but clearly patients must remain compliant with therapy for optimal results.