Assessing inter-rater agreement of the intellectual disability-frailty index short form: A descriptive pilot study.

Frailty is a health concern for many adults with intellectual disability and should be measured to detect at-risk conditions, monitor disease, plan treatment, and gauge mortality. This descriptive pilot study evaluated measurement consistency (inter-rater agreement) of the Intellectual Disability-Frailty Index Short Form among multiple assessors with 20 adults (M age = 48.3 years) who had intellectual and multiple disabilities. Agreement percentages were computed for (a) non-frail, pre-frail, and frail categories derived from total index scores, and (b) each of 17 deficits listed on the form. Low average inter-rater agreement (<85%) was obtained on the index frail categories, several of the assessed deficits had acceptable inter-rater agreement (84.2-100%), while the majority of deficits were associated with moderate-to-low agreement percentages. Though research supports the Intellectual Disability-Frailty Index Short Form as a valid and practical frailty assessment instrument, our findings suggest that full-scale inter-rater agreement must be improved by adding more specificity to the form, clarifying instructions for assessors, and providing competency-based training in assessment implementation.

Teaching clinicians and nurses to prepare for and present at interdisciplinary meetings through behavioral skills training.

Behavior analysts frequently collaborate with interdisciplinary colleagues to share information and make decisions about client services. This study evaluated the effects of behavioral skills training on preparation for and presentation during interdisciplinary review team meetings by clinicians (n = 4) and nurses (n = 4) at a residential school for students with intellectual and neurodevelopmental disabilities. The primary dependent measure was the percentage of preparation and presentation steps from task-analyzed behavior checklists that the participants implemented correctly. As evaluated by multiple-baseline designs, the participants improved their preparation and presentation skills to nearly 100% following behavioral skills training, maintained performance 1 month after the study, and rated training positively. We discuss elements of the training program, practice implications, and research directions.

Multiyear Evaluation of Maintenance Electroconvulsive Therapy in an Adult With Autism Spectrum Disorder, Catatonia, and Challenging Behavior.

ABSTRACT: We report the case of a 30-year-old man diagnosed with autism spectrum disorder who received electroconvulsive therapy (ECT) over a 4-year period to treat catatonia associated with life-threatening self-injury, aggression, major depression, and associated self-care, daily living, and communication skills deficits. A systematic schedule of maintenance ECT (m-ECT) was associated with elimination of challenging behavior, catatonic and depressive symptom remission, removal of protective equipment, and reduced dosages of psychotropic medications.

Behavioral assessment and faded bedtime intervention for delayed sleep-onset in an adult with autism spectrum disorder.

Faded bedtime has been evaluated as a behavioral intervention for delayed sleep-onset principally with children and youth who have intellectual and developmental disabilities in hospital and home settings. The present case report describes behavioral assessment and faded bedtime intervention in a 21-year old adult man with autism spectrum disorder at a community-based group home. The study also documented the effects of family home visits on the man's sleep when he returned to the group home. Compared to a pre-intervention (baseline) phase, faded bedtime was associated with increased intervals of recorded sleep and a decrease in sleep-onset latency over several months of implementation. We discuss clinical implications of the case and generality of findings across populations and settings.

Brief Report: A Pilot Investigation of Safety Concerns Among Direct Service Providers for Adults with Intellectual and Developmental Disabilities.

We designed and distributed a survey that assessed safety concerns experienced by direct service providers (DSPs) (N = 59) of adults with intellectual and developmental disabilities (IDD) in community-based group homes at a single human services organization. Results indicated relatively few safety concerns among the respondents from a list of 25 survey statements. Possible influences on the findings are presented such as safety training of the DSPs, comprehensive safety guidelines in place at the group homes, and conditions occasioned by the COVID-19 pandemic. Current safety research in IDD supports the necessity of assessment to inform prevention and intervention strategies.

Public speaking disfluencies: A review of habit reversal training and research.

From 2016 to 2022, the Journal of Applied Behavior Analysis published 7 studies that evaluated the effects of habit reversal training on speech disfluencies (filled pauses) during public speaking. This review summarizes the participants, dependent variables, procedures, experimental design, and outcomes from this research including practice implications and suggested areas of inquiry.

Psychotropic Medication Monitoring in a Human Services Organization for Children with Autism Spectrum Disorder: Description and Evaluation of Interdisciplinary Team Review.

Children with autism spectrum disorder (ASD) are often prescribed psychotropic medications but pharmacotherapy is typically conducted and evaluated based on clinical judgement without reference to objective measurement of treatment effectiveness and combined efficacy of pharmacological-behavioral interventions. We describe an interdisciplinary review team (IRT) model at a human services organization for children with ASD that was designed to standardize a process of psychotropic medication monitoring through (1) coordinated involvement of medical, nursing, behavior analyst, and special education professionals, (2) parent-guardian participation, (3) data-driven decision making, and (4) high-level administrative support. Our description includes case illustrations of medication reduction-elimination trials with five students and social validity assessment of IRT clinicians, nurses, and parent-guardians. Key components of the IRT model are emphasized with associated practice and research recommendations.

Behavioral Training and Performance Management of Human Services Organization Care Providers During the COVID-19 Pandemic.

Objectives: This report describes a model of training and performance management that was designed for and implemented with care providers at a residential school for children with neurodevelopmental and intellectual disabilities in response to the COVID-19 pandemic. The model focused on health and safety concerns, risk mitigation, and intervention integrity. Methods: Procedures followed an applied behavior analysis (ABA) and organizational behavior management (OBM) framework. Action plans addressed (a) critical COVID-19 protocols, (b) behavior-specific implementation guidelines, (c) remote and in-person training formats, (d) in vivo supervision, and (e) knowledge and performance assessments. Results: A competency evaluation (field study) revealed that participant care providers (N = 25) acquired and maintained COVID-19 protocols at near 100% proficiency immediately following and 1-month post-training. Supervisors had uniformly positive approval and acceptance ratings of school responsiveness to the COVID-19 pandemic. Conclusions: Integrated and evidence-based care provider training and supervisory practices can promote risk mitigation and performance effectiveness during health crises such as the COVID-19 pandemic. More controlled research that includes multiple dependent measures is needed to replicate and extend our findings to similar human services settings.

Organizational Responsiveness to the COVID-19 Pandemic: a Mixed Methods Social Validity Assessment of Human Services Care Providers.

Objectives: The COVID-19 pandemic posed many challenges to human services organizations serving persons with pre-existing conditions and health concerns. Study objectives were to assess organizational responsiveness to the pandemic through training, safety, and risk mitigation initiatives at community-based group homes for adults with intellectual disability (ID) and acquired brain injury (ABI). Method: This was a two-phase mixed methods study with human services care providers. In phase 1, 54 focus group participants responded to standardized interviews about leadership actions in the early months of the COVID-19 pandemic and discussed implementation effectiveness. These qualitative findings informed the design and distribution of a multi-item questionnaire in phase 2 that quantified acceptance and approval of leadership actions among 498 participants. Results: Both focus group and questionnaire participants identified several consistent leadership actions that had a positive impact on risk mitigation, health promotion, and participant satisfaction. Participants also converged on priority needs and recommendations for performance improvement. Conclusions: The study supports previous research on the effects of pandemic health crises among frontline healthcare workers and more definitively the impact on direct care providers of adults with ID and ABI during COVID-19. Care providers were able to judge organizational effectiveness and provide feedback to aide strategic planning. Mixed methods research provides an approach to large-scale program evaluation through integrated qualitative and quantitative analyses.

Effects of a peer-mediated performance improvement intervention on recording of child well-body checks by educational care-providers.

We report the effects of peer-mediated training as a performance improvement intervention on recording of well-body checks by classroom instructors at a specialized school for children and youth. The instructors were trained as peer mediators and then assumed performance monitoring responsibilities in the classroom. Compared to baseline phases in a withdrawal design, peer-mediation increased recording of well-body checks to near-100% among the instructors. Results of the study document positive training effects on a critical health and wellness objective, support and expand the limited research base concerning the effects of peer-mediated training, suggest further application of such training in human services settings.

Applied behavior analysis measurement, assessment, and treatment of sleep and sleep-related problems.

This discussion article considers applied behavior analysis measurement, assessment, and treatment of sleep and sleep-related problems among infants, children, and youth who are typically developing and have neurodevelopmental disabilities. Measurement has concentrated on designing practitioner-implemented methods and improving fidelity of data recording through sleep-monitoring instrumentation. The emphasis of assessment is identifying antecedent and consequence variables that promote sleep and evoke and maintain sleep-related problems. Treatment research has evaluated several effective interventions for problems such as delayed sleep-onset, night and early morning waking, bedtime resistance, and unwanted co-sleeping. Early and contemporary applied behavior analysis research is reviewed relative to function-based treatment formulation, intervention integrity, social validity, and research-to-practice translation.

Teaching students with autism spectrum disorder to tolerate haircutting.

We describe intervention with 2 adolescent male students who had autism spectrum disorder (ASD) and resisted haircutting performed by care providers at a residential school. The students were exposed to a graduated hierarchy of steps including the presence of hair clippers, and increased duration of hair clippers against their scalp and hair. Edible reinforcement was presented contingent on completion of a step without interfering behavior. Both students learned to tolerate all of the steps in the graduated hierarchy and a full haircut with maintenance at 2-, 4-, and 6-month follow-up. The study supports previous tolerance-training research with children and youth who have intellectual and developmental disabilities and resist personal care and hygiene routines.

Improving Classroom Appearance and Organization Through a Supervisory Performance Improvement Intervention.

This study evaluated the effects of a supervisory intervention on maintenance of appearance and organization in classrooms at a human services program for children and youths. The intervention combined performance feedback to classroom staff, public posting of performance outcomes, and eligibility for a performance-based incentive. Conducted in a multiple-baseline design, intervention was immediately and consistently effective in all classrooms. These findings support organizational behavior management applications within human services programs to improve performance that is related to environmental care.

Video Modeling Training Effects on Types of Attention Delivered by Educational Care-Providers.

We evaluated the effects of abbreviated (i.e., one-session) video modeling on delivery of student-preferred attention by educational care-providers. The video depicted a novel care-provider interacting with and delivering attention to the student. Within a concurrent multiple baseline design, video modeling increased delivery of the targeted attention for all participants as well as their delivery of another type of attention that was not trained although these effects were variable within and between care-providers. We discuss the clinical and training implications from these findings.

Refining Supervisory Practices in the Field of Behavior Analysis: Introduction to the Special Section on Supervision.

The rapid growth in the number of behavior analysts and aspiring behavior analysts creates an imperative for effective and efficient supervisory practices. Many behavior analysts receive little to no explicit instruction and mentoring in supervision practices while they are in training themselves. Those behavior analysts may then be expected to provide supervision for a range of individuals soon after graduation and certification and throughout the remainder of their career. The papers included in this special issue offer guidance for establishing and maintaining supervisory relationships, understanding the importance of each of the ethical guidelines for supervision, structuring group supervision experiences, managing problems that can arise during the course of a supervisory relationship, and arranging models of supervision within human service organizations.

Towards a Competency-Based, Ethical, and Socially Valid Approach to the Supervision of Applied Behavior Analytic Trainees.

Competency-based supervision of trainees has recently come to the forefront of behavior analytic practice; however, there are minimal data to support the effectiveness of various supervision practices on trainee outcomes. Accordingly, this paper is intended to spark further discussion and research activity regarding the supervision of those seeking to become Board Certified Behavior Analysts (BCBA). We present a practice model and considerations for supervising applied behavior analytic trainees consistent with the Behavior Analyst Certification Board (BACB) Supervisor Training Curriculum Outline (Behavior Analyst Certification Board, 2012b), the Professional and Ethical Compliance Code for Behavior Analysts (Behavior Analyst Certification Board, 2014), and extant literature from behavior analysis and related fields. Inherent to the current model is a focus on bi-directional feedback and collaboration between the supervisor and trainee to frequently evaluate the acceptability of the procedures, process, outcomes, and effectiveness of supervision. We present a Supervision Monitoring and Evaluation Form consistent with the current model and discuss the assumed importance of objective and subjective self-assessment of supervisor competence to the ultimate advancement of the practice of applied behavior analysis.

Behavioral treatment of rumination: Research and clinical applications.

This brief review describes research on rumination treatment that emphasizes functional analysis, recent intervention methods (supplemental feeding, fixed-time stimulus presentation, continuous access to preferred stimulation), clinical implications, and procedural recommendations.