Behavioral Consultation Research Articles

Applying behavioral analytic consultation to schools to assess and treat a student's elopement

AbstractA team of behavioral consultants applied the Behavioral Analytic Consultation to Schools model while working with educators in a public school setting to evaluate and treat elopement behavior of an 11‐year‐old student with autism spectrum disorder. Assessment conducted by the consultants included interviews, descriptive analysis, preference assessment, trial‐based functional analysis of elopement, and a reinforcer analysis conducted using an alternating treatment design. An acceptable behavior intervention was developed in consultation with educational staff and family. Consultants trained educational staff on procedures to implement the intervention and data collection. When intervention components were implemented as designed, the student's elopement in the classroom and out of the school building decreased. This study is an example of a successful application of the Behavioral Analytic Consultation to Schools model where consultants take primary responsibility for the evaluation, and collaborate with educational team members and family members to apply what was learned from the assessment to a successful intervention. The results of this application of the model provide continued support for evaluating the use of the model to improve outcomes for students engaging in severe behavior in public school settings.

Behavior Analysis Goes to School: Teacher Acceptability of Behavior-Analytic Language in Behavioral Consultation.

Effective communication is a vital component of behavioral consultation. Behavioral consultants (e.g., behavior analysts, school psychologists) are responsible for drafting behavior intervention plans, delivering accessible training, and providing concise and consumable feedback to teachers. Their reliance on technological descriptions to communicate behavioral principles and procedures may yield poor social validity and hinder the consultant-teacher relationship. In this study, we recruited 164 teachers through Amazon Mechanical Turk and administered a survey to (a) evaluate the social acceptability of technical and nontechnical language used in behavioral consultation across a variety of student populations and (b) gain information about teachers' experiences with behavioral consultation. Implications are discussed for training and the provision of behavioral consultation services.

Creating a Just and Joyful World for Dogs

Framing debates about how we should relate to companion animals as "rights vs welfare" is misleading and potentially harmful. Far from being the sole territory of abolitionists, many working behavior consultants today are using concepts that come from animal rights theory, although they may not recognize them as such. This article uses the theories of Sue Donaldson and Will Kymlicka to explain how animal rights can inform how we relate to and treat companion animals in our care, and argues that extending rights to our pets is both a moral obligation and a logical conclusion to the beliefs many behavior consultants already evince.

Conjoint Behavioral Consultation for a Child with Autism Spectrum Disorder and Selective Mutism Who is Prone to School Refusal

Conjoint Behavioral Consultation for a Child with Autism Spectrum Disorder and Selective Mutism Who is Prone to School Refusal

Effects of Behavioral Consultation in a Nursery School Class: Individualized Support and Classwide Approach

近年、特別な支援を要する児への対応が求められているが、現場で活用できるリソースには限界があり、コンサルテーションのニーズは高まってきている。本研究では、保育所における行動コンサルテーションの効果を明らかにすることを目的とした。また、コンサルティ自身が機能的アセスメントを実施できるようになるためのコンサルテーションのあり方についても考察した。クライエントは4歳児クラス（特別な支援を要する幼児3名を含む）、コンサルティは担任保育士2名であった。対象クラスは20名であり、一部の児の離席、退室や攻撃行動、およびクラス全体の頻繁な私語がみられていた。7回のコンサルテーションにより、適応行動への注目や代替行動の強化など、児の行動の機能に応じた対応が可能となり、対象児の離席、退室や攻撃行動、クラス全体の私語が減少した。今後は保育士自身が機能的アセスメントを行うことが望まれる。

Using behavioural skills training via telehealth to increase teachers use of communication interventions and increase student use of speech-generating devices in a high school functional skills classroom.

Behavioural skills training (BST) has demonstrated effectiveness in training teachers in evidence-based interventions to increase communication for children with limited repertoires. However, research has yet to extend to youth with developmental disabilities who are learning to communicate using speech-generating devices. The emergent use of telehealth technology in applied behaviour analysis has been associated with greater access to therapeutic services. Although the use of telehealth has been extended as an avenue for parents to access behavioural intervention services for their child, fewer studies have evaluated the use of telehealth for teacher behavioural consultation or with adolescents and young adults with complex communication needs. In the present study, four teaching staff were trained via telehealth to implement communication facilitation strategies with augmentative and alterative communication users in a high school functional skills classroom. During the coaching sessions, the staff were provided BST on the basic behaviour analytic teaching strategies (e.g. assessing preference, environmental arrangement, and reinforcement strategies). Independent adapted ABAB designs were used to evaluate the effectiveness of modified BST delivered via telehealth on increased teaching staff-implemented communication opportunities within the functional skills classroom and the effectiveness of staff-implemented communication intervention on increased speech-generating device mands for four adolescents/young adults with developmental disabilities. The results indicated that the improved staff fidelity of the communication interventions was associated with the increased level of independent student mands for each dyad. Lastly, social validity data suggest that the procedures were acceptable and feasible. These data indicate that the use of telehealth may be a viable model for specialised classroom consultation. The use of a telehealth delivery model to train classroom staff may be a viable option when specialised support is necessary, but access is limited.

Adaptation of the CarFreeMe driver retirement intervention to provide driving cessation support to older people living with dementia

AbstractObjective:Driving and stopping driving present challenging issues for older people living with memory problems and the family members supporting them. Changes to driving status impact the individual stopping driving and their family members. CarFreeMe is an existing, effective driving cessation program for older people that may be applicable to older people living with dementia. The purpose of this study was to adapt the program and explore feasibility and key stakeholder perspectives.Methods:The Medical Research Council guidelines for conducting research into complex interventions guided the development, acceptability and feasibility piloting. A multidisciplinary approach was taken, and key stakeholders were involved throughout the process. This included an adaptation process, followed by expert reference group feedback and case series pilot study.Results:The background research indicated that some key changes were required to meet the needs of people living with dementia. Aspects of the content, language, format and activities were adapted and an additional module was created for family members – whose involvement was identified as important. A more personalized, flexible approach was recommended. The expert reference group [psychologists (n= 2), occupational therapists (n= 3) and dementia behavior consultants (n= 2)] indicated the program was appropriate and needed, and made recommendations for feasibility. Pilot testing with three families indicated acceptability.Conclusion:A driving cessation program adapted for use with people living with dementia and their families required some changes to meet the needs and situations based on feedback from key stakeholders. Future studies will evaluate implementation outcomes across a range of settings.

Mucocutaneous Manifestations in HIV-Infected Patients and Their Relationship to CD4 Lymphocyte Counts.

Background More than 90% of human immunodeficiency virus- (HIV-) infected patients show at least one mucocutaneous manifestation during the course of their disease. The frequency, pattern, and associated factors of these complications vary among different populations. Objective This study was planned to evaluate the frequency of cutaneous presentations in HIV-infected patients and their association with the count of CD4 cells. Methods A cross-sectional study was conducted on eighty-four HIV-positive patients, who attended the Behavior Consultation Center of Arak University of Medical Sciences. All subjects had a complete physical examination by an expert dermatologist. Further diagnostic procedures were performed, if necessary. Counts of CD4 were determined using flow cytometry. Results From 84 patients who enrolled in this study, 95.2% manifested at least one type of mucocutaneous lesions. The most common presentation was xerosis, followed by seborrheic dermatitis, herpes simplex, and oral candidiasis. Oral candidiasis and furuncle were significantly associated with decrease in CD4 cell counts. Conclusions Cutaneous manifestations are common in HIV-positive patients, some of which (oral candidiasis and furuncle) could be applicable as useful clinical indicators to predict the immune status of the patients. Therefore, regular skin examinations are recommended as routine HIV-infected patients' healthcare programs.

The Need for a National Accreditation Programme for Professionals Working in the Field of Animal Training and Behavioural Modification in New Zealand.

Simple SummaryCompanion animals play an important role in the lives of New Zealanders. Animals’ guardians often engage professional behaviour and training support to ensure their companion animal’s behaviour is compatible with their lifestyle and expectations. The methods these professionals use vary substantially and potentially subject animals to psychological (and physical) harm where outdated, incorrect or aversive methods of training or equipment are used. The national regulation of training methods or techniques would safeguard the welfare of the animal benefactors of these services. In the absence of such regulation, the development of a national accreditation body may act to protect animal welfare by certifying the experience, qualifications and training methods of the professionals offering these services. We investigated industry opinion and readiness for the establishment of an accreditation body via an online survey and found that accreditation, promoting the use of reward-based training and behavioural modification techniques, was generally supported. We conclude that the establishment of a national accreditation body would ensure that those seeking services source professionals who use best practice when it comes to training and behavioural modification, resulting in lasting benefits to animal welfare. Companion animals are at risk of psychological (and physical) harm if outdated, incorrect or aversive methods of training or equipment are used during training and behavioural modification. Companion animal guardians often engage professional animal behaviour and training services, yet this industry is not regulated in New Zealand. A voluntary national accreditation and registration programme could act to protect the welfare of animals by robustly evaluating the experience, qualifications and training methods of industry professionals. To investigate industry readiness for a national accreditation programme, we conducted an online survey and analysed the responses of 262 animal trainers, behavioural consultants, dog safety educators, veterinarians and veterinary nurses. A national accreditation programme, promoting the use of reward-based training and behavioural modification techniques, was generally supported, especially by individuals holding qualifications and membership of professional organisations. The implementation of such a programme would ensure that those seeking these services are able to source professionals that use best practice when it comes to training and behavioural modification, with lasting benefits to animal welfare.

Effects of Self-Monitoring of Antecedents and Consequences on the Mother of an Adolescent Child Exhibiting Behavior Problems

Behavioral consultation using an antecedent-behavior-consequence (A-B-C) narrative recording chart was implemented in this study with the mother of an adolescent child to examine whether improving the accuracy of the mother’s monitoring of antecedents and consequences would lead to decreases in problem behaviors in parent–child interactions. A single-case A-B design with follow-up was applied. At the baseline, the mother recorded parent–child interactions after learning how to complete the chart. In the intervention, we provided positive corrective feedback on maternal performance. Following the intervention, problem behaviors decreased with improved monitoring accuracy. The results suggest conditions under which self-monitoring procedures function effectively.

Unpacking Conjoint Behavioral Consultation: A Latent Profile Analysis of Parent-Teacher Interactions

ABSTRACT Conjoint behavioral consultation (CBC) is a model of consultation wherein parents and teachers partner to address children’s social-behavioral concerns. The teacher-parent relationship has proven critical to the success of CBC, yet little is known about the dynamics in CBC that may promote these relationships. This study explored interactions among teachers and parents during CBC. Using latent profile analysis, four interactional sense-making behaviors (i.e., engagement, perspective-taking, turn-taking, and coherence) were examined among 193 parents and teachers participating in CBC. Three classes of interactions emerged – one class characterized by high interactional sense-making (18%), another characterized by moderate interactional sense-making (69%), and one class characterized by low interactional sense-making (13%). Follow-up analyses suggested differences in the quality of this relationship based on the interactions displayed by parents and teachers, with dyads that displayed high and moderate patterns of interactional sense-making reporting better quality relationships than those demonstrating low patterns of interactional sense-making.

A Mobile Health Intervention for Fetal Alcohol Spectrum Disorders (Families Moving Forward Connect): Development and Qualitative Evaluation of Design and Functionalities.

BackgroundFetal alcohol spectrum disorders (FASD) affect approximately 2% to 5% of the US population. However, most families are unable to access FASD-informed interventions. Barriers to care include the lack of a knowledgeable and skilled workforce and family-level barriers such as limited financial resources, inability to access childcare, and stigma. As a result, families often try peer-to-peer and self-help support strategies. However, they often take these strategies from disparate sources, which have quite variable intervention quality and empirical support.ObjectiveThis study aimed to initiate systematic development and evaluation of a mobile health intervention (app) for caregivers raising children with FASD. Focus groups were conducted to elicit participant perspectives on app design and functionalities to inform further app development.MethodsThe app, called FMF Connect, was derived from the scientifically validated Families Moving Forward (FMF) Program, a clinician-delivered behavioral consultation intervention. FMF Connect was intended for caregiver self-delivery and included five main components: (1) Learning Modules, (2) Family Forum, (3) Library, (4) Notebook, and (5) Dashboard. Focus group methods were used to solicit perspectives from diverse families during the early stages of app development. Questions were asked about interface design, relevance of components and content, and perceived barriers and facilitators of use. A total of 25 caregivers participated in 7 focus groups across 5 US cities. Data were analyzed thematically.ResultsFocus group participants were generally enthusiastic about the app interface design and components. Four global positive impression themes emerged, including (1) ease of access, (2) how the app guides and organizes information, (3) connection to other users and information, and (4) ability to share some content with others. Themes arose not only in discussions relating to positive app features but also when participants were asked about motivators for app use. Participants related how these positive global themes could address some system-level barriers, such as limited access to services, feeling isolated, and increased advocacy needs related to the societal lack of FASD knowledge. Participants identified many positive features about individual app components and functionalities. They also communicated potential barriers to use and raised important concerns and considerations relating to several app components. These included recognizability of the app based on the logo, and the balance of following the planned intervention sequence versus obtaining immediate answers. Also mentioned were privacy and dynamics within the Family Forum.ConclusionsFMF Connect is a promising novel intervention with potential to reach many families in need and reduce significant barriers to care, resulting in a broader public health impact. Study findings will guide further app development both in terms of content and technological advances to optimize intervention effects. FMF Connect app development provides useful directions for other apps aimed at changing parenting practices.

介護現場における認知症の行動・心理症状(BPSD)に関する行動コンサルテーションの仕組み作り : フローチャート化した手順の適用可能性に関する事例的検討

介護現場における認知症の行動・心理症状(BPSD)に関する行動コンサルテーションの仕組み作り : フローチャート化した手順の適用可能性に関する事例的検討

The efficacy of problem-solving consultation for homeschooled students with behavior concerns.

The purpose of this study was to explore the efficacy and acceptability of problem-solving consultation for homeschooling families with children who exhibited externalizing behavior problems. Three families participated, with multiple siblings participating from each family. Six children were male and 1 child was female. Children's ages ranged from 5 to 9 years old. Single-case experimental multiple baseline designs were used to evaluate the functional relation between implementation of behavior support plans within problem-solving consultation and children's externalizing behaviors. Direct observation data showed decreases in externalizing behaviors after the consultation and intervention process for 2 of the 3 families. The parents of the homeschooling children reported that the behavior support plans and consultation process were acceptable. Implications for future research and practice are presented. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Computational Analysis of Movement Patterns of Dogs with ADHD-Like Behavior.

Simple SummaryADHD-like (attention deficit hyperactivity disorder) behavior in dogs may be expressed as impulsivity, inattentiveness, or aggression, compromising both dog and owner quality of life. Its treatment in a clinical setting requires behavioral modification and sometimes a medical treatment is added. There is a lack of objective tools for assessment and diagnosis of the problem, and behavioral experts mostly rely on owner reports. To address this gap, in this paper we use a self-developed computational tool which automatically analyzes movement of a dog from video footage collected during behavioral consultation. Based on a computational analysis of behavioral consultations of 12 dogs medically treated due to ADHD-like behavior and of a control group of 12 dogs with no reported behavioral problems, we identify three dimensions of characteristic movement patterns of dogs with ADHD-like behaviors, which are detectable during consultation. These include (i) high speed of movement, (ii) large coverage of room space, and (iii) frequent re-orientation in room space. These patterns can form the basis for computational methods for objective assessment of dogs with ADHD-like behavior that could help for diagnosis and clinical treatment of the disorder.Computational approaches were called for to address the challenges of more objective behavior assessment which would be less reliant on owner reports. This study aims to use computational analysis for investigating a hypothesis that dogs with ADHD-like (attention deficit hyperactivity disorder) behavior exhibit characteristic movement patterns directly observable during veterinary consultation. Behavioral consultations of 12 dogs medically treated due to ADHD-like behavior were recorded, as well as of a control group of 12 dogs with no reported behavioral problems. Computational analysis with a self-developed tool based on computer vision and machine learning was performed, analyzing 12 movement parameters that can be extracted from automatic dog tracking data. Significant differences in seven movement parameters were found, which led to the identification of three dimensions of movement patterns which may be instrumental for more objective assessment of ADHD-like behavior by clinicians, while being directly observable during consultation. These include (i) high speed, (ii) large coverage of space, and (iii) constant re-orientation in space. Computational tools used on video data collected during consultation have the potential to support quantifiable assessment of ADHD-like behavior informed by the identified dimensions.

Examining the Efficacy of Conjoint Behavioral Consultation for Middle School Students With Externalizing Behavior Problems

This exploratory study examined the efficacy of Conjoint Behavioral Consultation for addressing classroom disruptive behavior for middle school students with externalizing behavior problems. In addition, the parent–teacher relationship, parent and teacher competence in problem-solving, and acceptability were examined. Participants were parents and teachers of four middle school students with externalizing behavior problems. Disruptive classroom behavior data were examined in a concurrent multiple baseline across participants design. Parent–teacher relationship, competence in problem-solving, and acceptability data were examined descriptively. Findings suggested improvements in disruptive behavior for each participant. However, limitations impeded interpretations. Parent–teacher relationship data were inconclusive. Six out of eight parents and teachers with pretest and posttest data reported improvements in their competence in problem-solving. All parents and teachers perceived the consultation process favorably. Limitations and future directions are discussed.

Conjoint Behavioral Consultation for Students Exhibiting Symptoms of ADHD: Effects at Post-treatment and One-Year Follow-Up

Both behavioral and pharmacological interventions have short-term efficacy for reducing symptomology of attention-deficit/hyperactivity disorder (ADHD). However, intervention effects typically dissipate once interventions are removed. Scholars have advocated for a life-course model of intervention to sustain outcomes for students with ADHD. This model of service delivery is collaborative, individually tailored, and responsive to the culture and context of the student. Conjoint behavioral consultation (CBC) is a family–school partnership intervention that is consistent with a life-course model and has demonstrated efficacy in the short- and long-term reductions of problem behaviors; however, little is known about the efficacy of CBC for students with ADHD specifically. The present study sought to evaluate the efficacy of CBC for students exhibiting symptoms of ADHD immediately following treatment and 12 month later using data from a larger randomized controlled trial. Results indicated that students in the CBC condition (n = 29) had significantly lower parent ratings of hyperactivity and behavioral symptoms at post-treatment relative to students in the “business as usual” control condition (n = 16). However, at follow-up, differences were no longer statistically significant. Additionally, although both groups demonstrated significant improvements in teacher-reported attention problems at post-treatment, students in the control group had significantly lower scores at follow-up. Implications for the use of CBC for students with ADHD symptomology and future research directions are discussed.

Preliminary Findings of Culturally Responsive Consultation with Educators.

Behavior analysts are increasingly called to serve culturally and linguistically diverse populations. The culture of a population can provide context in which to identify behaviors likely to be reinforced by the client's social environment, stimuli established as reinforcers for client behavior, and behavioral repertoires shaped by the client's social environment. One of the largest and fastest growing minority groups in the United States is the Latinx population. This article offers preliminary evidence of incorporating cultural adaptations into the context of behavioral consultation for the Latinx population. Cultural adaptation of behavioral consultation can lead to improved outcomes for educators. In this study, 5 educators received behavioral consultation consisting of behavioral skills training to implement culturally responsive class-wide behavior management procedures. All 5 educators improved their treatment fidelity of the culturally responsive behavior management practices. Implications for practitioners and future research are discussed.

Exercise for advanced prostate cancer: a multicomponent, feasibility, trial protocol for men with metastatic castrate-resistant prostate cancer (EXACT)

BackgroundMen with metastatic castrate-resistant prostate cancer can experience an array of treatment-related side effects. Accumulating evidence suggests exercise may alleviate some of these adversities and assist in disease management. However, empirical evidence in advanced prostate cancer patients remains limited. The purpose of this study is to determine whether men with metastatic prostate cancer, who are ineligible for high-intensity exercise, can partake in a home-based, moderate-intensity exercise program and the impact of doing so on quality of life and physical fitness parameters.MethodsThirty men with adenocarcinoma of the prostate and progressive systemic, metastatic disease will be recruited. Clinicians will screen patients against inclusion criteria to determine eligibility. All men enrolled will be prescribed a tailored, home-based, moderate-intensity exercise intervention consisting of aerobic and strengthening components for 12 weeks. Patients will receive supplementary education materials and weekly behavioural change consultations throughout the intervention. The primary outcome will be the feasibility of delivering such an intervention in men with metastatic disease. Secondary endpoints including skeletal events will be monitored for safety, as will the feasibility of patient-reported outcome measures and the sampling time points, generating data pertaining to completion rates and potential effect in future trials. General physical fitness will be assessed during these visits, using timed sit-to-stand testing and a 6-min walking test. Prior to each visit, objective physical activity levels will be captured for 7 days using an accelerometer, to determine the feasibility of this technology and the quality of data obtained. In parallel with the feasibility aspects of the trial, changes compared to baseline will be reported. Direct regular contact will also serve as a feedback loop, should any issues arise. This study has received ethical approval from the Office for Research Ethics Committees Northern Ireland.ConclusionsThis study aims to determine the potential utility of a home-based exercise intervention in managing side effects associated with advanced prostate cancer and its treatment. This feasibility trial will inform the design and implementation of a larger randomised control trial to determine the efficacy of moderate aerobic and strengthening exercise as an adjuvant therapy in men with metastatic prostate cancer. Collecting such evidence provides further support for exercise in this paradigm and potential for its inclusion as a low-toxicity therapy in standard cancer care, in the longer term.Trial registrationClinicalTrials.gov, NCT03658486Trial sponsor: Queen’s University Belfast (Reference: B18/15). Contact: Dr. Paula Tighe, Research and Enterprise, Queen’s University Belfast. Telephone: 02890 973,296. Email: p.tighe@qub.ac.uk. The sponsor reviewed the protocol and ethical application prior to submission.Protocol issue: Version 1 (18th May 2018). Authors: MB, MM, SJ and GP.

Randomized Trial of First-Line Behavioral Intervention to Reduce Need for Medication in Children with ADHD

A study conducted in an analogue summer treatment setting showed that when concurrently receiving behavioral intervention, many children with Attention-Deficit Hyperactivity Disorder (ADHD) did not need medication or maximized responsiveness at very low doses. The present study followed participants in that summer study into the subsequent school year to investigate whether the same pattern would extend to the natural school and home settings. There were 127 unmedicated children with ADHD between the ages of 5 and 13 who were randomly assigned to receive or not receive behavioral consultation (BC) at the start of the school year. Children were evaluated by teachers and parents each week to determine if central nervous system stimulant treatment was needed. Children who received BC were approximately half as likely those who did not (NoBC) to initiate medication use each week at school or home and used lower doses when medicated at school. This produced a 40% reduction in total methylphenidate exposure over the course of the school year. BC and NoBC groups did not significantly differ on end-of-year teacher or parent ratings of behavior, which were positive. Moreover, BC and NoBC groups did not significantly differ in cost of treatment; although children in the BC condition accrued additional costs via the BC, these costs were offset by the associated delay and reduction in medication use. Results add to a growing literature suggesting that the use of low-intensity behavioral intervention as a first-line treatment reduces or eliminates the need for medication in children with ADHD.