Rapid Conversion from Clinic to Telehealth Behavioral Services During the COVID-19 Pandemic.

Survival often depends on behavior that can adapt to rapid changes in contingencies, which should be particularly well suited to a contingency-sensitive and data-based discipline such as applied behavior analysis (ABA). The speed and scale with which contingencies shifted in early March 2020 due to the effects of COVID-19 represent a textbook case for rapid adaptation with a direct impact on the survival of many types of enterprises. We describe here the impact, changes, and outcomes achieved by a large, multifaceted ABA clinical program that has (a) ongoing data that forecasted and tracked changes, (b) staff well practiced with data-based shifts in operations (behavior), and (c) up-to-date information (data) on policy and regulations. The results showed rapid shifts in client and staff behavior on a daily basis, shifts in services from in-person services to telehealth, and increases in volumes, revenue, and margins. We detail regulations and provide actionable steps that clinical organizations can take pertinent to this shift now and in the future. The challenges of the COVID-19 pandemic underscore the importance of maintaining robust coordination and communication across our field in order to address crises that affect our field.

Retention in Outpatient Child Behavioral Health Services Among Military and Civilian Families.

Retention in treatment for children with behavior problems is critical to achieve successful outcomes, and clinical evidence suggests the behavioral health needs and retention of military-connected and civilian families differ meaningfully. Military and civilian children in outpatient behavioral treatment were compared in terms of presenting problems as well as appointment adherence (n = 446 children and their parents). Demographics and rates of externalizing behavior were similar across the two groups. More military than civilian children had internalizing problems. Military parents had more parenting distress and depressive symptoms. Fewer military families dropped out of treatment early. Within-military comparisons demonstrated that children whose parent had recently deployed were more likely to have internalizing problems and poor adaptive skills. Although retention was better among military families, the early treatment drop-out proportions (20-30%) for both groups highlight a barrier to effective behavioral intervention.

Parent training: acquisition and generalization of discrete trials teaching skills with parents of children with autism.

This study examined the effects of an intensive parent training program on the acquisition and generalization of discrete trial teaching (DTT) procedures with two parents of children with autism. Over the course of the program, parents applied the DTT procedures to teach four different functional skills to their children, which allowed for an assessment of "free" and programmed generalization across stimulus exemplars. Parent training was conducted by the first author utilizing instructions, demonstrations, role-play, and practice with feedback. Parents' use of DTT skills and children's correct and incorrect responding were measured. A within-subject multiple-baseline across stimulus exemplars (functional skills taught) design was employed both to demonstrate control of the training program over parents' correct use of DTT, and to allow a preliminary investigation of the generalized effects of training to multiple stimulus exemplars. Results demonstrate initial control of the training program over parent responding, and the extent to which each parent extended her use of DTT procedures across untrained and topographically different child skills. The potential for designing more generalizable and thus more cost-effective parent training programs is discussed.