Association for Behavior Analysis International

The best designed behavioral interventions will have limited efficacy if they are not implemented appropriately. It is widely recognized that caregivers will not implement interventions perfectly, but the minimal levels of integrity necessary to obtain behavior change have not been identified for most behavioral interventions. The current symposium provides three studies that systematically assessed sub-optimal levels of treatment integrity as it related to the Hi-P instructional sequence, discrete trial instruction, and three-step prompting and evaluated procedures to promote integral implementation by caregivers.

Decreases in treatment integrity reduce the effectiveness of empirically-validated treatments such as discrete-trial instruction (DTI). Global measures of treatment integrity may mask deficits in implementing individual treatment components. Recent research has shown that decreases in the integrity of individual components of DTI can result in differential decreases in treatment effectiveness. Video modeling can be an effective and efficient method of promoting improved DTI treatment integrity globally. This study examined whether video models tailored to individual components of DTI would result in improvements in treatment integrity in individual components and globally. Four undergraduates were initially provided written instructions for implementing DTI. The undergraduates then implemented DTI with children, and researchers measured DTI treatment integrity both globally and by individual component. Deficits were found in multiple components, especially reinforcer delivery. Showing the undergraduates a video model of correct reinforcer delivery was ineffective at promoting treatment integrity for that specific component, but written feedback and behavioral skills training were effective in improving treatment integrity in individual components and globally. Clinicians should monitor measures of treatment integrity both globally and in individual treatment components to make feedback to staff more efficient and ensure the best treatment for their clients.

Noncompliance is one of the most common behavioral referrals for child psychologists. Interventions based upon response prompting, escape extinction, and differential reinforcement (collectively referred to as three-step prompting) have been demonstrated to be effective for remediating this problem repeatedly, but less attention has been provided to best practice in equipping parents with these skills. Miles and Wilder (2009) demonstrated the efficacy of behavioral skills training (BST) in teaching parents three-step prompting, but the BST approach is effortful and requires onsite coaching of a professional. Further, the effects of this training were only assessed on a target set of instructions. In application, it will be important to ensure that caregivers can implement these procedures across a variety of instructional situations. The current study served as a systematic replication and extension of Miles and Wilder. Specifically, the current study (a) conducted a component analysis of BST to assess the sufficient and necessary components that lead to skill acquisition and (b) evaluated generalization of parents implementation of these procedures across a variety of tasks. We found that the full training package including written instructions, modeling, and feedback yielded the highest levels of treatment integrity and these behaviors generalized across tasks.