Assessment-based Interventions Research Articles

Effectiveness of holistic assessment-based interventions in improving outcomes in adults with multiple long-term conditions and/or frailty: an umbrella review protocol.

This umbrella review will synthesize evidence on the effectiveness of holistic assessment-based interventions in improving health outcomes in adults (aged ≥18) with multiple long-term conditions and/or frailty. Health systems need evidence-based effective interventions to improve health outcomes for adults with multiple long-term conditions. Holistic assessment-based interventions are effective in older people admitted to hospital (usually called "comprehensive geriatric assessments" in that context); however, the evidence is inconclusive on whether similar interventions are effective in community settings. We will include systematic reviews examining the effectiveness of community and/or hospital holistic assessment-based interventions in improving health outcomes for community-dwelling and hospitalized adults aged ≥ 18 with multiple long-term conditions and/or frailty. The review will follow the JBI methodology for umbrella reviews. MEDLINE, Embase, PsycINFO, CINAHL Plus, Scopus, ASSIA, Cochrane Library, and the TRIP Medical Database will be searched to identify reviews published in English from 2010 till the present. This will be followed by a manual search of reference lists of included reviews to identify additional reviews. Two reviewers will independently screen titles and abstracts against the selection criteria, followed by screening of full texts. Methodological quality will be assessed using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses and data will be extracted using an adapted and piloted JBI data extraction tool. The summary of findings will be presented in tabular format, with narrative descriptions and visual indications. The citation matrix will be generated and the corrected covered area calculated to analyze the overlap in primary studies across the reviews. PROSPERO CRD42022363217.

Optimising Medications in Older Vascular Surgery Patients Through Geriatric Co-management.

Prescribing of potentially inappropriate medications and under-prescribing of guideline-recommended medications for cardiovascular risk modification have both been associated with negative outcomes in older adults. Hospitalisation represents an important opportunity to optimise medication use and may be achieved through geriatrician-led interventions. We aimed to evaluate whether implementation of a novel model of care called Geriatric Comanagement of older Vascular (GeriCO-V) surgery patients is associated with improvements in medication prescribing. We used a prospective pre-post study design. The intervention was a geriatric co-management model, where a geriatrician delivered comprehensive geriatric assessment-based interventions including a routine medication review. We included consecutively admitted patients to the vascular surgery unit at a tertiary academic centre aged ≥65 years with an expected length of stay of ≥2 days and who were discharged from hospital. Outcomes of interest were the prevalence of at least one potentially inappropriate medication as defined by the Beers Criteria at admission and discharge, and rates of cessation of at least one potentially inappropriate medication present on admission. In the subgroup of patients with peripheral arterial disease, the prevalence of guideline-recommended medications on discharge was determined. There were 137 patients in the pre-intervention group (median [interquartile range] age: 80.0 [74.0-85.0] years, 83 [60.6%] with peripheral arterial disease) and 132 patients in the post-intervention group (median [interquartile range] age: 79.0 (73.0-84.0) years, 75 [56.8%] with peripheral arterial disease). There was no change in the prevalence of potentially inappropriate medication use from admission to discharge in either group (pre-intervention: 74.5% on admission vs 75.2% on discharge; post-intervention: 72.0% vs 72.7%, p = 0.65). Forty-five percent of pre-intervention group patients had at least one potentially inappropriate medication present on admission ceased, compared with 36% of post-intervention group patients (p = 0.11). A higher number of patients with peripheral arterial disease in the post-intervention group were discharged on antiplatelet agent therapy (63 [84.0%] vs 53 [63.9%], p = 0.004) and lipid-lowering therapy (58 [77.3%] vs 55 [66.3%], p = 0.12). Geriatric co-management was associated with an improvement in guideline-recommended antiplatelet agent prescribing aimed at cardiovascular risk modification for older vascular surgery patients. The prevalence of potentially inappropriate medications was high in this population, and was not reduced with geriatric co-management.

Building Site–Level Capacity for Functional Assessment-Based Interventions: Outcomes of a Professional Learning Series

In this replication and extension study, we examined the effects of educators’ participation in practice-based professional learning (PBPL) to design, implement, and evaluate functional assessment-based interventions (FABIs). We randomly assigned school-site teams ( k = 69; N = 342) to cohorts trained by either university or state technical assistance providers. In a randomized cluster design, we replicated and extended previous research by examining procedural integrity, participant learning outcomes, completion and quality levels of PBPL-FABI activities, and student outcomes. Results provide (a) additional evidence to support PBPL-FABI in improving school-site teams’ knowledge, confidence, and use and (b) initial evidence for its scalability, as evidenced by state technical assistance providers’ high implementation levels comparable with university trainers. We conclude with a discussion regarding PBPL-FABI and considerations for future research.

Implementing Functional Assessment–Based Interventions in Secondary Settings: Strategies for Overcoming Barriers

Secondary students with specific learning disabilities (SLD) can often demonstrate skill deficits and problem behaviors in general education classes. Teachers generally understand how to implement intensive interventions, yet may not know how to address skill deficits and off-task behaviors using a function-based approach or may encounter barriers to implementation. In this article, we present barriers to implementation that may occur in secondary settings. To help educators make decisions, we offer recommendations and resources to overcome these barriers to implementing functional assessment-based interventions in secondary schools.

Comparing Functional Behavior Assessment-Based Interventions and Non-functional Behavior Assessment-Based Interventions: A Systematic Review of Outcomes and Methodological Quality of Studies

This review compared the effectiveness of functional behavior assessment-based interventions (FBAI) versus non-functional behavior assessment-based interventions (NFBAI) through an examination of 24 single-case design (SCD) studies that directly compared the effects of these intervention approaches. This review also systematically examined the quality of these studies. All of the reviewed studies reported relative effectiveness of FBAI over NFBAI in reducing problem behaviors, showing a higher percentage of behavior reduction in FBAI than NFBAI conditions. None of the reviewed studies met all of the What Works Clearinghouse Design Standards for SCD (Kratochwill et al. in Single-case designs technical documentation, 2010). We discussed methods of comparing the effects of FBAI versus NFBAI and made methodological suggestions for future research in this area.

Functional Behavioral Assessment-based interventions on adults’ delusions, hallucinations and disorganized speech: A single case meta-analysis

The Functional Behavioral Assessment (FBA) approach involves the use of single-case designs (SCD) to study the problem behavior-environment contingencies and conduct interventions that consider this functional relationship. Although this approach has been considered an evidence-based practice (EBP) for the treatment of several psychological problems, no meta-analytic studies of FBA-based interventions on delusions, hallucinations and disorganized speech -commonly operationalized as “atypical vocalizations”- have been carried out. Therefore, the purpose of this study was to review and synthesize the results of FBA-based interventions on adults' atypical vocalizations. We conducted a systematic review and a multi-level meta-analysis of these interventions, using a recently developed effect size estimator for SCD studies (i.e., log response ratio). All the studies that met our eligibility criteria provided evidence supporting the effectiveness of FBA-based interventions on atypical vocalizations, with an overall average effect size of a 72% reduction. Both the publication year and the methodological quality were found to be significant moderators. Despite some methodological limitations, we can conclude that FBA-based interventions are effective to reduce atypical vocalizations. The implications of these results could be of interest for the mental health community.

Perspectives on Functional (Behavioral) Assessment

In the 25 years since the publication of the article reprinted in this issue of Behavioral Disorders, a tremendous amount of research and opinion has been published on the topics of functional analysis, functional assessment, and assessment-based interventions. In this commentary, we reflect on the context in which our original work was conducted and briefly consider changes that have occurred and challenges that remain.

Improving Educators’ Knowledge, Confidence, and Usefulness of Functional Assessment-based Interventions: Outcomes of Professional Learning

Improving Educators’ Knowledge, Confidence, and Usefulness of Functional Assessment-based Interventions: Outcomes of Professional Learning

Functional assessment-based interventions: Focusing on the environment and considering function

ABSTRACTIt can be challenging for educators to select intervention tactics based on the function of the student's behavior. In this article, authors offer practical information on behavioral function and environmental-focused intervention ideas for educators developing behavior intervention plans. Ideas are organized according to the hypothesized function of the student's behavior of concern. Authors conclude with additional considerations for educators implementing behavior intervention plans to support students with the most intensive intervention needs.

The Impact of Universal Teacher Practices and Function-based Behavior Interventions on the Rates of Problem Behaviors among At-risk Students

The call for effective instructional and classroom management is frequent within the professional literature. However, type, amount, and sequence of strategies sufficient to impact rates of problem behavior are often missing or listed with limited guidance on differentiation based on student pattern of problem behavior. The purpose of this study was to examine the impact of universal teacher practices on general education students exhibiting problem behaviors, and the impact of such practices on specific students given the function of problem behavior. Specifically, this study was interested in exploring the extent to which universal teacher practices, when applied for all students in the classroom, impacted student behavior in general education settings. Additionally, this study was interested in examining the additive effect of combining both targeted classroom supports in the form of universal teacher practices and functional behavioral assessment-based interventions through a multiple-baseline design. Results indicated that when universal teacher practices are applied, rates of problem behaviors decrease based on the function of behavior. Implications for practice and research are discussed.

A Review of the Evidence Base of Functional Assessment-based Interventions for Young Students Using One Systematic Approach

This review of the literature was conducted to explore the evidence base for functional assessment-based interventions (FABIs) for one systematic approach developed by Umbreit, Ferro, Liaupsin, and Lane (2007). Specifically, this review examined the evidence base for this systematic approach to FABI for young students by applying quality indicators and evidence-based standards. A secondary purpose was to identify the extent to which classroom teachers were involved in the FABI process. Twelve studies met the inclusion criteria of intervening with young students (i.e., preschool through third grade) with or at risk for disabilities using this one systematic approach to FABI. Although seven studies demonstrated positive effects and met all eight quality indicators (Council for Exceptional Children [CEC], 2014), indicating they were methodologically sound, these seven cases represented 14 students falling short of the recommended 20 participants (CEC, 2014). This review provides evidence for deeming this FABI model a potential evidence-based practice for use with young students. Limitations and future direction are discussed.

Examining the Effects of Functional Assessment-Based Interventions With High School Students

In two studies, the systematic approach to designing functional assessment-based interventions (FABIs) created by Umbreit, Ferro, Liaupsin, and Lane (2007) was used with high school students receiving special education services in self-contained classrooms reserved for students with persistent behavior problems. In Study 1, an AB design was used with a male student with high rates of off-task behavior. In Study 2, an ABAB design was used with a female student exhibiting inappropriate language. Results from both studies indicated that a multi-component FABI can decrease target behaviors for high school students. Treatment fidelity data indicated that a less complicated intervention may increase the accuracy with which interventions are implemented. Brief discussions of each study as well as an overall discussion synthesizing findings across studies are included.

Improving Teachers’ Knowledge of Functional Assessment-based Interventions: Outcomes of a Professional Development Series

This paper provides outcomes of a study examining the effectiveness of a year-long professional development training series designed to support in-service educators in learning a systematic approach to functional assessment-based interventions developed by Umbreit and colleagues (2007) that has met with demonstrated success when implemented with university supports. Forty-eight educators attended a 4-day, practice-based professional development series, with coaching and applied practice occurring between sessions. Participants completed pre- and post-training surveys to evaluate their perceived knowledge, confidence, and usefulness as well as actual knowledge of 15 concepts and strategies addressed in the training series. Outcomes as well as implications for professional development to support in-service teachers and school personnel in learning how to design, implement, and evaluate functional assessment-based interventions are offered. Results indicated statistically significant improvements in each concept and strategy measured. Findings are discussed in light of noted limitations, with recommendations offered to improve subsequent professional development efforts.

The effectiveness of health interventions in cardiovascular risk reduction among emergency service personnel

The physical demands and hazards associated with emergency service work place particular stress on responders' cardiovascular systems. Indeed, cardiovascular disease (CVD) is a significant problem for emergency service personnel. Although it may be difficult to alter the cardiovascular health hazards associated with the work environment, it is possible for personnel to control their modifiable CVD risk factors, cardiovascular fitness levels and subsequently, reduce their CVD risk. This review aimed to determine the effectiveness and methodological quality of health interventions designed to mitigate CVD risk in emergency service personnel. A literature search of electronic journal databases was performed. Sixteen relevant studies were assessed for methodological quality using a standardised assessment tool. Data regarding the effectiveness of each intervention were extracted and synthesised in a narrative format. Fifteen studies were rated 'Weak' and one study was rated 'Strong'. Interventions which combined behavioural counselling, exercise and nutrition were more effective in improving cardiovascular health than nutrition, exercise or CVD risk factor assessment-based interventions alone. Further, CVD risk factor assessment in isolation proved to be an ineffective intervention type to reduce CVD risk. Combined interventions appear most effective in improving the cardiovascular health of emergency service personnel. Accordingly, fire and emergency service agencies should consider trialling multifaceted interventions to improve the cardiovascular health of personnel and avoid interventions focused only on one of nutrition, exercise or CVD risk factor assessment. However, as most studies were methodologically weak, further studies of a higher methodological quality are needed.

AN INDIVIDUALIZED AND COMPREHENSIVE APPROACH TO TREATING SLEEP PROBLEMS IN YOUNG CHILDREN

We evaluated the effects of assessment-based interventions on the treatment of sleep problems in 3 young children, 2 of whom had been diagnosed with autism. We used sleep diaries and infrared nighttime video in the child's bedroom to obtain measures of sleep onset, sleep-interfering behaviors, night waking, total sleep, parental presence, and medication administration each night. We then identified environmental factors that contributed to sleep problems using an open-ended interview called the Sleep Assessment and Treatment Tool. Individualized treatment packages were designed with the children's parents based on the idiosyncratic results of the assessment. Treatment packages included adjustment of the sleep schedule based on developmental norms and current sleep phases, design of a sleep-conducive environment, elimination of inappropriate sleep dependencies, and function-based interventions to decrease sleep-interfering behaviors by disrupting the contingency between the interfering behavior and its likely reinforcement. A nonconcurrent multiple baseline design across subjects revealed that treatment was effective for all 3 children. In addition, social acceptability measures showed that the parents were satisfied with the assessment process, the treatment, and the amount of behavior change.

Functional Behavioral Assessment-Based Interventions for Students with or at Risk for Emotional and/or Behavioral Disorders in School: A Hierarchical Linear Modeling Meta-Analysis

Of the myriad practices currently utilized for students with disabilities, particularly students with or at risk for emotional and/or behavioral disorder (EBD), functional behavior assessment (FBA) is a practice with an emerging solid research base. However, the FBA research base relies on single-subject design (SSD) and synthesis has relied on literature review or analyses using nonparametric effect size calculations. This study was designed to examine the omnibus effect that FBA-based interventions have on problem behaviors for students with or at risk for EBD in schools using a hierarchical linear modeling meta-analytic approach to SSD synthesis. Based on a sample of 69 FBA studies, 146 subjects, and 206 outcome graphs, results indicated that, overall, FBA-based interventions reduced problem behavior by an average of 70.5% and that the procedure was effective across all student characteristics. Differences of effectiveness were evident between functional analysis and descriptive assessment procedures. Findings of this study suggest that FBA-based interventions for students with or at risk for EBD are an effective approach for the reduction of problem behaviors.

Using Self-Regulation Strategies and Functional Assessment-Based Interventions to Provide Academic and Behavioral Support to Students at Risk Within Three-Tiered Models of Prevention

Some students exhibit behavioral issues as early as preschool and kindergarten. Conventional wisdom suggests waiting to see whether students outgrow these difficulties. However, there is extensive evidence that early detection and intervention is preferred to the wait-and-see approach because it is more likely to result in better academic and social outcomes later in students’ school careers. Schoolwide Positive Behavior Support is a multitiered model that uses primary, secondary, and tertiary levels of support to provide an instructive approach to behavior, as opposed to more reactive models. This article introduces suggestions for secondary and tertiary supports—self-regulation strategies and functional assessment-based interventions, respectively—to meet the multiple needs (academic, behavioral, and social) of students at risk for negative outcomes caused by behavioral issues.

Risk Factors and Risk Assessment in Juvenile Fire-Setting

This article provides an overview of the literature on risk issues in juvenile fire-setting behaviour. In particular, we highlight the importance of acknowledging the differences in terminology used in current studies and outline the importance of developmental issues in understanding when fire-related activities should be considered pathological. The estimated prevalence of fire interest, fire play, fire-setting and arson are discussed. The key sociodemographic, individual and environmental factors that are associated with pathological fire-setting are discussed in the context of general delinquency. The limited findings, to date, suggest that fire-setting in the main is similar to non-fire-setting delinquent behaviour in juveniles as the majority have conduct disorder rather than major mental illness. There is some very limited evidence that attentional problems may have a specific association with fire-setting but this requires replication on a larger scale. Risk assessment for those who have engaged in fire-setting behaviour is contextualised within the model outlined in the United States Federal Emergency Management Agency (FEMA) as this is one of the leading international agencies conducting work in this field. A variety of available risk assessment tools are outlined and the utility of FEMA models and screening tools for assigning cases to appropriate risk assessment-based interventions is outlined. Additional clinically based tools are discussed and their value in treatment/management assignment decisions is highlighted. Using a risk model for fire-setting, it is clear that multiagency working is crucial in designating cases to higher levels of multi-disciplinary assessment and treatment. At present, current international and Australian interventions for juveniles largely focus on educational and fire safety awareness programmes and there is a lack of structured clinically based programmes that meet the needs of those higher-risk juveniles who have unmet mental health and social needs.

Collaborating with Parents in Reducing Children's Challenging Behaviors: Linking Functional Assessment to Intervention

The relationship between a functional assessment-based parent intervention and preschoolers' challenging behaviors was examined in the current study. A single subject design with a multiple baseline across 2 parent-child dyads was implemented. The researchers collaborated with parents to design the FA-based interventions and parents received varying levels of support throughout the study. Results indicate that parents were able to implement the functional assessment-based interventions, and these interventions effectively reduced children's challenging behaviors. In addition, parents continued implementing the intervention strategies following termination of the intervention, and children's challenging behaviors remained low.

Designing and Evaluating Assessment-Based Interventions to Reduce Stereotypy Among Adults With Autism in a Community Job

We designed and evaluated assessment-based interventions to reduce stereotypy among three adults with severe autism in a community job setting. An initial descriptive assessment, conducted during the regular work routine in the employing company, indicated that stereotypy occurred while the supported workers were waiting for work assignments or when they stopped working on an assigned task. An on-the-job functional analysis was then conducted; the results showed that the stereotypy of each worker was not maintained by socially-mediated consequences. Individualized interventions were then designed for increasing work behavior to compete with stereotypy by restructuring the job routine to reduce wait time and/or prompting and praising work behavior more frequently. The interventions increased work behavior and were accompanied by decreased stereotypy for each worker. Guidelines for practitioners and future research directions are offered, focusing on the use of assessment-based interventions for reducing stereotypy within community jobs.