Applied Behavior Analysis Services Research Articles

Evaluating an Applied Behavior Analysis Training Package for Ukrainian Refugee Caregivers of Autistic Children in the Czech Republic

Russia’s war on Ukraine has displaced millions. For autistic children this resulted in the loss of services based on applied behavior analysis (ABA). To develop a model of culturally competent, high-efficacy, family-centered, and fidelity driven ABA services for displaced Ukrainian families in Czechia, this study piloted a package teaching caregivers to build skills with their autistic children. Using a multiple probe design, practitioners collaboratively selected targets, lectured, and held coaching sessions. Results demonstrated that the program was socially valid, contributed to parental skill gains, and in a broader context can serve as a foundation for future work serving refugee families.

Barriers to Receiving Applied Behavior Analysis Services in Children With Autism Spectrum Disorder

Barriers to Receiving Applied Behavior Analysis Services in Children With Autism Spectrum Disorder

Supervision Strategies for Treatment Fidelity and Job Satisfaction in Applied Behavior Analysis Services

Supervising behavior technicians in the implementation of services derived from the science of applied behavior analysis with children diagnosed with autism spectrum disorder (ASD) is a common practice for behavior analysts. However, there is limited training available on supervision strategies for those applying this model of services. Lack of training can lead to ineffective and inconsistent supervisory practices, resulting in low rates of job satisfaction for supervisees and variable fidelity in treatment implementation. The quality of supervision can improve job satisfaction and treatment fidelity. This study was conducted using a nonconcurrent multiple baseline design across participants to evaluate the effects of an evidence-based approached to supervision on treatment fidelity and job satisfactory for three behavior technicians providing services for a child with ASD. Each of the three technicians demonstrated improved levels of treatment fidelity and increased job satisfaction across several facets of their job during the intervention and maintenance phase. Implications of these findings, limitations of this study, and suggestions for future research are included.

Assessing the social validity of telehealth‐based applied behavior analysis services for autism spectrum disorder

AbstractDuring the COVID‐19 pandemic, applied behavior analysis services for many autistic individuals were transitioned to telehealth. The current study assessed caregiver‐reported quality of life (QoL) and social validity for families of autistic children receiving only telehealth services (n = 96) or a combination of telehealth and in‐person services (n = 173). Barriers to the telehealth experience were analyzed via an ANOVA, and the impact of funding source was analyzed using an independent samples t‐test. Caregivers reported benefit across QoL and social validity items, with scores ranging from 3.31 to 4.44 (1 = least benefit, 5 = most benefit). While many caregivers reported no barriers regarding technology (44.61%), childcare (69.52%), and employment (64.68%), the presence of those barriers significantly impacted QoL and social validity scores. Funding source was not found to have a significant impact. Overall, caregivers found value in their child's telehealth services. Clinicians have an obligation to mitigate barriers to ensure the success of the intervention.

Challenging Case: Leveraging Community Partnerships to Address Barriers to Care for Students with Autism.

Sam is an 11-year-old young boy with autism spectrum disorder (ASD), unspecified anxiety disorder, and attention-deficit/hyperactivity disorder, combined presentation. He was initially diagnosed with ASD at 6 years of age after evaluation by a developmental-behavioral (DB) pediatrician. He presents to the DB pediatrics clinic to reestablish care. He established care with psychiatry 5 months ago after his school referred him to a hospital-school-community telepartnership bridge program following statements of self-harm and numerous concerns with his behavior, including elopement.Sam currently receives special education support under the classifications of "Emotional Disturbance" and "Speech Impairment." His parents report significant challenges with having his medical diagnosis of autism recognized by the school, which has impeded him receiving educational support as a student with autism. This has resulted in Sam being penalized for challenging behaviors related to his neurodevelopmental disorder. He is not currently making meaningful progress in the school setting. Sam currently demonstrates avoidance, physical and verbal aggression, and difficulty adapting to change across settings. In addition to difficulties advocating for more individualized support at school, Sam has never received applied behavior analysis (ABA) therapy because of challenges obtaining insurance approval. There are no additional barriers to accessing care, such as language, geographic, or socioeconomic factors.Sam's visit to reestablish care with DB pediatrics consisted of an individual clinician evaluation model. The Childhood Autism Rating Scale, Second Edition, (CARS-2) and Vineland Adaptive Behavior Scales, Third Edition (Vineland-3), were administered, and Sam continued to meet DSM-5 criteria for ASD following re-evaluation. A new referral for ABA therapy was submitted. Shortly afterward, his family received an insurance denial letter specifying that additional developmental testing was needed before ABA therapy would be approved. His clinician called the insurance company to appeal this decision but was unsuccessful. Sam was then seen by the DB pediatrics embedded psychologist, who completed additional testing, including assessment of cognitive functioning, administration of the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), and autism-specific rating scales. This process led to further delays in access to ABA services. Throughout this process, the parents reported feeling helpless and frustrated given the barriers faced in receiving appropriate services. What are your next steps to advocate for supports through the school and insurance company?

Learning from the Czech Republic’s experiences with growing applied behavior analysis services for children with autism

ABSTRACT Prior to 2016 applied behavior analysis (ABA) was relatively unknown in the Czech Republic. However, the region’s ABA community has grown exponentially over the last six years. This growth may be attributed to the work of families and professionals linked to the region’s autistic community. This progress has not been without challenges. Along the way, there have been numerous vocal opponents across various fields. Despite pushback, the headstrong ABA community has managed to: establish ABA professional organizations, hold ABA conferences, train various professionals in ABA, and pass laws surrounding the profession and its practice. Through efforts such as holding free community-based workshops, creating ABA-centric continuing education trainings for other helping professions, recruiting local media coverage, collaborating with other organizations, presenting multiple exemplars of case studies using ABA-based methods across disciplines, and lobbying the government for change, ABA is on its way to becoming a more available option for supporting those with autism in the area. This paper shares the trials and tribulations of the region, hoping that the experiences and actionable points here can help move similar nations towards ABA dissemination and professional establishment.

A mixed-methods examination of clinicians' perceived barriers to telehealth delivered applied behavior analysis.

Following the COVID-19 pandemic, clinicians relied on telehealth to ensure continuity of essential healthcare services, such as Applied Behavior Analysis (ABA). Identifying barriers and examining them in the context of other implementation outcomes is important to support appropriate adaptations and sustainability of telehealth-delivered ABA services. Convergent mixed methods design was utilized to identify barriers experienced by ABA clinicians (N = 388) when delivering ABA services over telehealth to autistic children and their families following the first six months of the COVID-19 pandemic. Additionally, barriers were examined in relation to telehealth implementation outcomes and intentions for continued adoption. Findings reveal that clinicians rated providing direct services (M = 3.52, SD = 1.14) as more difficult than conducting assessments (M = 3.29, SD = 1.06), and both as more difficult than providing parent-mediated interventions [(M = 2.47, SD = 1.11), F(2, 381) = 162.26, p < 0.001]. A principal components analysis indicated a 3-factor solution of barriers related to: (1) technology (α = 0.82), (2) administrative tasks (α = 0.88), and (3) client characteristics (α = 0.88). The most frequently endorsed barriers were related to client characteristics, including increased difficulty providing telehealth services to children who elope (M = 4.37, SD = 0.81), children who exhibit challenging behaviors (M = 4.31; SD = 0.83), and children who are in the preverbal stage or use nonverbal language to communicate (M = 4.07; SD = 1.00). Fewer barriers related to client characteristics uniquely predicted implementation variables including acceptability, appropriateness, and feasibility. Thematic analysis revealed challenges related to technology, caregiver involvement, child engagement, implementation of intervention strategies over telehealth, and administrative or logistical barriers. These findings highlight the need for targeted strategies that facilitate telehealth use to address specific client needs and support the implementation of telehealth services in usual care settings.

Lag schedules to increase variability in responding in a home setting

AbstractSeveral studies have demonstrated that lag schedules can be used to increase variability in controlled settings. In this study, we replicated these procedures during regular home applied behavior analysis services using available resources with an adolescent with Autism Spectrum Disorder. The participant had learned multiple responses to questions but responded with little to no variability. The intervention included scripted prompts and lag schedules implemented across social contexts in a multiple baseline design. The scripted prompts assisted the participant in varying his responding and assisted the interventionists in monitoring and accurately implementing the lag schedule intervention. Results showed a systematic increase in varied responses across multiple social contexts, suggesting that lag schedules can be implemented with positive effects in naturalistic therapy settings.

Data-driven, client-centric applied behavior analysis treatment-dose optimization improves functional outcomes

BackgroundWith increasing numbers of individuals diagnosed with autism spectrum disorder (ASD) and with affirmation of applied behavior analysis (ABA) as an evidence-based standard of care for ASD, there has been a proliferation of agencies offering ABA services over the last several decades. Disagreement exists among ABA providers and health plans that reimburse those providers on the optimal number of hours of ABA services that should be reimbursed. This study aims to understand whether children who receive more hours of ABA therapy achieve better outcomes and to evaluate the impact of the COVID-19-induced shift to telehealth clinical supervision on outcomes.MethodsA retrospective cohort analysis was performed using data from the Vineland 3 Comprehensive Interview Form to assess function throughout ABA treatment. Paired sample t tests, independent sample t tests, Cohen’s D, and Pearson correlations were used to determine relationships between Vineland scores and input variables including hours of service and modality of supervision (in-person vs. telehealth).ResultsWhile statistically and clinically significant improvements in function were observed, children appear to have improved outcomes independent of the number of hours of service received. There were also no significant associations between modality of supervision and Vineland standard scores.ConclusionsThese findings challenge prior research that demonstrated a linear dose–response relationship. By tailoring treatment dosage to the individual client’s needs, providers may be able to better maximize functional progress of the client, to preserve family time, and to utilize health plan dollars more efficiently.

Discussion and Conceptual Analysis of Four Group Contingencies for Behavioral Process Improvement in an ABA Service Delivery Quality Framework.

Applied behavior analysis (ABA) organizations that provide services to children with autism can apply contingencies to improve employee performance or behavioral processes. Such contingencies may be especially important for maximizing ABA service delivery quality (ASDQ). For some behavioral processes, group contingencies applied to the behavior of individuals within the process may be more appropriate than individualized contingencies. In the history of the profession, behavior analysts have used group contingencies at the operant level of selection, such as independent, interdependent, and dependent group contingencies. However, recent experimental work in culturo-behavioral science suggests the metacontingency, an analogue of the operant contingency at the cultural level of selection, can also control the behavior of individuals in a group. This article discusses how such group-oriented contingencies could be used by managers in organizations in behavioral process improvement efforts to target key performance indicators of quality in an ASDQ framework. The paper ends with a discussion of limitations and future research.

Piloting an E-Learning Applied Behavior Analysis Course for Caregivers of Children with Autism in the Czech Republic.

The telehealth model can allow for cost-effective supports in areas where limited applied behavior analysis (ABA) services are available. As a result, e-learning programs for parents of children with autism have become part of the telehealth paradigm. In the Czech Republic, one of the many places where there are limited ABA supports and no available ABA e-learning courses for families, the development of an e-learning course that is freely available, and linguistically and culturally appropriate, is needed. It was anticipated that this course could mirror some of the free e-learning materials available to English-speaking caregivers and provide foundational knowledge to later support more intensive ABA services. Therefore, a pilot study was developed to assess an ABA e-learning course for caregivers in the Czech Republic with the aim of validating its efficacy and assessing whether a synchronous component was needed for the best outcomes. The materials were not meant to replace best practices in more intensive caregiver training but provide foundational skills for later more successful local services. Results demonstrated that a total of 33 caregivers completed the course, making statistically significant gains in their ABA knowledge and rating the course highly. Interestingly, the addition of the synchronous component only impacted the knowledge gain outcome. Suggestions for supporting caregivers in e-learning course completion and directions for future research are additionally explored.

Examining the perceptions of needs, services and abilities of Czech and North Macedonian caregivers of children with autism and trainers

Effective practices for supporting families with autistic children ensure a match between their needs and the expectations and competencies of the clinician. Applied behavior analysis (ABA) services are a common provision for serving autistic individuals. However, in regions where ABA is in its infancy, like the Czech Republic and North Macedonia, culturally relevant resources, regulations for practice, and standardized coursework are missing. In their absence, it is necessary to investigate the degree to which practitioners in the regions are meeting the behavioral needs of families. Assessing this match can set the stage for establishing more stable and effective services in the areas, as well as neighboring countries with similar historical foundations. Therefore, a survey was conducted to examine the perceptions of caregivers and trainers (those who self-identified as providing support to families with autistic children). A total of 233 caregivers and 204 trainers participated. Analysis of the survey responses verified the lack of behavioral knowledge on the part of the trainers, the apparent lack of access to ABA services for families in both regions, a potential misalignment between family needs and training targets, and the disparities between the two countries. The information evaluated here can be used to guide preservice training, dissemination efforts, and regulations surrounding behavioral practices.

Preliminary Practice Recommendations for Telehealth Direct Applied Behavior Analysis Services with Children with Autism.

This article provides preliminary practice recommendations for telehealth direct applied behavior analysis (ABA) services for children with autism. In the face of COVID-19, there is an immediate need for discussion on how to implement various ABA procedures via telehealth for ABA practitioners. Alongside emerging scientific evidence on the effectiveness of telehealth direct service as well as various service-related guidelines, we provide preliminary practice recommendations that are based on the existing literature on in-person and telehealth ABA procedures. We also discuss these recommendations with case studies of two boys with autism. Social validity measures indicated that families were satisfied with telehealth direct services. Even after the COVID-19 pandemic has resolved itself, telehealth direct ABA service will still be a valuable option for remote and international locations where direct ABA service is limited, and thus, practice recommendations continue to be relevant for all practitioners that use telehealth direct service.

The Use of a Pictorially Enhanced Self-Instruction Packet to Improve Weekly Time Sheet Completion in an ABA Clinic

ABSTRACT Applied behavior analysis (ABA) has steadily grown over the previous 30 years due in large part to its effectiveness as a treatment for autism spectrum disorder (ASD) and other developmental disabilities. This growth has led to increasing insurance coverage for ABA services used to treat ASD. Accurate insurance billing practices are critical for timely payment for services, correct reflection of services provided, and are ethically mandated. Incomplete or incorrect billing invoices can cause payment delays, require time to correct billing records, and in some cases cost ABA companies money in the form of lost time and/or insurance paybacks. The purpose of the present study was to assess the effectiveness of a pictorially enhanced self-instruction (PESI) packet to improve the completion of weekly billing sheets turned in by five technicians at a clinic providing ABA services to individuals with ASD and other developmental delays. Each technician was given a PESI packet that contained step-by-step directions with corresponding picture examples of how to complete portions of their weekly timesheet. Results indicated the packet was rapidly effective for increasing the completion of timesheets submitted for 4 of 5 technicians. Limitations and directions for future research are discussed.

The Impact of COVID-19 on the Operations of Applied Behavior Analysis Services: Implications for Telehealth and Workforce Support

The Impact of COVID-19 on the Operations of Applied Behavior Analysis Services: Implications for Telehealth and Workforce Support

Exploring Quality in the Applied Behavior Analysis Service Delivery Industry.

As the applied behavior analysis (ABA) service industry (“the industry”) continues to rapidly expand, it faces three major problems. First, ABA service delivery quality (ASDQ) is undefined in ABA research and the industry. Second, we cannot rely exclusively on professional organizations that oversee licensure and certification to control ABA service delivery quality because they do not have control over the relevant contingencies. Third, without objective indicators of ABA service delivery quality, it is difficult for ABA organizations to distinguish the quality of their services from competitors. In this article, first we explain the need for more critical discussion of ASDQ in the field at large, briefly describe a sample of common views of quality in ABA research and the industry, and identify some of their limitations. Then we define ASDQ and present a cohesive theoretical framework which brings ASDQ within the scope of our science so that we might take a more empirical approach to understanding and strengthening ASDQ. Next, we explain how organizations can use culturo-behavioral science to understand their organization’s cultural practices in terms of cultural selection and use the evidence-based practice of ABA at the organizational level to evaluate the extent to which methods targeting change initiatives result in high ASDQ. Lastly, in a call to action we provide ABA service delivery organizations with six steps they can take now to pursue high ASDQ by applying concepts from culturo-behavioral science and total quality management.

Sociodemographic, clinical characteristics, and service utilization of young children diagnosed with autism spectrum disorder at a research center in Saudi Arabia: The road to autism spectrum disorder diagnosis.

Objectives:To assess how clinical services are accessed and utilized by young children with suspected autism spectrum disorder (ASD) and identifying factors that prevent the early identification of developmental concerns and diagnosis.Methods:This retrospective study examined the sociodemographic and clinical characteristics of a convenience sample of children diagnosed with ASD at the Center for Autism Research, Riyadh, Saudi Arabia between 2016 and 2018. The characteristics of ASD assessment and intervention service use were examined. Additionally, we examined the association between sociodemographic, clinical, and service use variables with the child’s age at the time of the parent’s initial concern and first ASD diagnosis, and the time from first concern to diagnosis.Results:Out of 127 cases, 67 were diagnosed with ASD (mean: 46.88 months, SD: 18.88, median: 42.00, range, 19-93). Most ASD cases had one previous assessment (n=28, 41.8%). Higher sibling numbers were associated with a later age of first concern (p=0.0278). Applied behavior analysis service utilization was associated with later age of first ASD diagnosis (p=0.0336) and longer time to ASD diagnosis (p=0.0301).Conclusion:Larger sample size is needed to further investigate whether these findings are representative of the national experience. Community-based intervention outcome studies should assess the quality of services being provided.

Firearms and Home-Based ABA Services: Considerations for Safe Practice.

Providers of applied behavior analysis (ABA) services often deliver therapeutic interventions within their clients' homes. Although the home environment offers numerous advantages for consumers, it can also pose unique threats to provider health and safety. When an unsecured firearm is discovered in the home of a client, service providers and agencies may not have the necessary knowledge to respond immediately to the situation nor how to ensure a safe therapeutic environment prior to the reinstatement of ABA services. This article aims to discuss strategies that agencies and service providers can use to reestablish a safe environment when they discover an unsecured firearm in the home. The authors will review federal guidelines, the Behavior Analyst Certification Board's Ethics Code for Behavior Analysts, offer suggestions for company policies, and discuss areas for skill building with caregivers and clients.

Self-Care Strategies and Job-Crafting Practices Among Behavior Analysts: Do They Predict Perceptions of Work-Life Balance, Work Engagement, and Burnout?

Applied behavior analysis (ABA) practitioners report high levels of burnout, exhibited as exhaustion and disengagement. Turnover, a stressful and costly experience for individual practitioners and the human service organizations that employ them, is a potential consequence of burnout. Work-life balance and work engagement are associated with lower burnout and lower intention to quit. Research concerning behavioral predictors of work-life balance, work engagement, and burnout-all of which are associated with turnover intentions-among ABA service providers is scant. Therefore, the purpose of the current study was to explore whether and how the use of self-care strategies and job-crafting practices influences perceived levels of work-life balance, work engagement, and burnout among ABA practitioners who work in human service settings. In a sample of 826 ABA practitioners, 72% reported medium to high levels of burnout. Hierarchical regression analyses revealed that the use of both self-care strategies and job-crafting practices strongly predicted work-life balance, work engagement, and burnout above and beyond sociodemographic variables (gender and years of experience). Findings can inform the development of effective organizational/systems- and individual-level self-care and job-crafting interventions that support sustainable individual, organizational, and client-related outcomes. We contend that self-care and job-crafting interventions support a culture of well-being in graduate programs, training/supervision curricula, and mentor-mentee relationships.

Board certified behavior analysts and school fidelity of Applied Behavior Analysis services: qualitative findings

The Federal government mandates the use of evidence-based practice for interventions with students. Applied Behavior Analysis (ABA) is one of these evidence-based practices, but despite this, many school systems do not implement ABA as described in the literature, which leads to loss of fidelity and integrity with implementation, and often results in ineffective interventions in the classroom. The research question “What are the experiences of Board Certified Behavior Analysis (BCBAs) who use evidence-based practices in conjunction with staff in schools for interventions with American K-12 students using ABA?” was developed to ascertain, from a BCBA’s perspective, why ABA interventions are not implemented with fidelity in classroom settings. Participants were BCBAs in the United States who consult and collaborate with school staff to implement ABA services for children with autism spectrum disorders (ASD). Findings indicate that BCBAs are not given adequate time or resources to provide sufficient training in ABA, that principles of ABA are sometimes misused in training in such a manner that exacerbates myths of ABA, and that a general lack of support from school administrators exists, all of which lead to a loss of implementation fidelity. This lack of implementation fidelity in turn leads to decreased outcomes for students with ASD in schools when ABA is not implemented with fidelity.