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| Treatment Integrity in Early Intensive Behavioral Services |
| Monday, May 30, 2005 |
| 3:00 PM–4:20 PM |
| Continental B (1st floor) |
| Area: AUT; Domain: Service Delivery |
| Chair: Peter C. Patch (Simmons College) |
| Discussant: Peter C. Patch (Simmons College) |
| CE Instructor: Peter C. Patch, Ph.D. |
| Abstract: Early intensive behavioral interventions are at the forefront of services to children newly diagnosed with a Pervasive Developmental Disorder. These services are generally provided in home settings in an individualized format by consultants, therapists, and instructional staff who travel among several children within a day. Given the increased costs associated with home based services, it is imperative that effective strategies be consistently implemented in order to maximize learning outcomes for each child. Research on treatment integrity has suggested that a gap often exists between services that are planned and services which are delivered, calling into question the effectiveness and efficiency of those services. While strategies for ensuring treatment integrity have appeared in the literature, very little research has examined the variables involved in ensuring treatment fidelity in home based services for young children with autism. This presentation examines several variables potentially impacting treatment integrity and child outcomes for children with autism in this environment. These variables include staff training procedures, prior experience of staff, duration of child sessions, and provision of staff feedback. |
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| Assuring the Generalization of Teaching Skills for Home-Based Instructors |
| JANICE R. BOLTON (HMEA), Michele D. Mayer (HMEA) |
| Abstract: With the growing need to provide services to children with autism, many agencies have begun to offer home based instruction to young children with autism. Growth in this service has outpaced the existing pool of trained instructors, leading agencies to develop inservice training programs aimed at developing teaching skills in paraprofessionals. It is important to evaluate the effectiveness of these training programs: do they assure that participants (1) have mastered the teaching skills that they are being trained in, and (2) can generalize these skills to the teaching setting? This becomes a critical issue in home based services, where opportunities for frequent on the job practice, observation, and performance feedback are difficult to provide. This study focused on a training program designed to teach paraprofessionals to implement discrete trial training. Baseline measures showed that participants completing the existing training program were able to perform this skill with an average accuracy rate of 84%. When additional practice using multiple exemplars, specific performance feedback, and a predetermined mastery criterion were implemented, participants accuracy in performing discrete trials increased and was seen to maintain in on the job performance. |
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| Investigating Treatment Integrity Differences Across Time Segments Within an Instructional Session |
| STACEY CONSIDINE (HMEA), Michele D. Mayer (HMEA), Sandra M. Beaton-Small (HMEA) |
| Abstract: Treatment integrity, defined as the extent to which the independent variable is implemented or carried out as planned, is a vital component when training staff to implement programs within home-based services for individuals with autism. However, once staff are working in the home setting, the assessment and monitoring of the independent variable is often overlooked. Practitioners frequently assume that trained staff will implement instructional strategies as planned and behavior change will result. While treatment integrity has been examined in a number of different settings, there is a dearth of research focusing on treatment fidelity in early intensive behavioral intervention for children with autism. There are a host of variables that may influence the fidelity of program implementation in a home environment. Two of those variables – length of the instructional session and prior staff experience – were examined in this study. Treatment integrity was measured across sessions of varying lengths with three instructors who differed in their amount of prior teaching experience with children with autism. All completed a standard agency in-service training program. Implications with respect to child performance and arrangement of instructional programming within a session will also be discussed. |
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| Does Improved Treatment Integrity Effect Child Outcomes in Discrete Trial Programming? |
| SANDRA M. BEATON-SMALL (HMEA), Michele D. Mayer (HMEA), Stacey Considine (HMEA) |
| Abstract: In order to evaluate the efficacy of discrete trial programs one must ensure that the program is implemented accurately by staff. One way to measure staff accuracy is to monitor the level of treatment integrity. There is evidence in the literature suggesting that treatment outcomes change in desired directions when procedures are implemented with high fidelity. The purpose of the current presentation was two-fold: (1) to evaluate the effects of written and oral feedback on staff implementation of discrete trial programs and (2) to evaluate the relationship between staff performance and child performance. Direct care staff with varying levels of experience implementing discrete trial programs served as participants. Child participants included young children diagnosed with a Pervasive Developmental Disorder who were receiving home based services. Treatment integrity and child performance were measured across ten common instructional programs. Results will be discussed with respect to efficacy of feedback, generalization to non-targeted programs, and relationship to child improvement. |
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