Behavior Support Research Articles

Integrated Behavioral Supports: Combining PBIS and SEL at Tier 2

Integrated Behavioral Supports: Combining PBIS and SEL at Tier 2

Introduction to the Special Issue: Focus on Families

Engaging with families to support their children’s social, emotional, and behavioral development is a key feature of positive behavior supports (PBSs). The purpose of this Special Series is to disseminate research on the application of PBSs with families and in home contexts. This issue contains five articles, including single case experimental designs, survey design, mixed-methods, and a literature synthesis. These articles provide a deeper understanding and clear implications for improving research and practice to increase family access, involvement, and benefit from PBSs.

Paraeducator Involvement in Positive Behavioral Interventions and Supports: A Brief Report

Paraeducators assume a range of responsibilities to assist school members in supporting students who receive special education services under the Individuals with Disabilities Education Act (2004). These responsibilities often include supporting the behavioral needs of students with extensive support needs. Given the growing adoption of school-wide positive behavioral interventions and supports (PBIS) as a framework for supporting students’ social, emotional, and behavioral needs and increasing reliance on paraeducators among schools in the United States, we conducted an exploratory survey study of 82 paraeducators to explore their involvement and perceived importance of involvement in various PBIS aspects, perceived barriers and facilitators of involvement in PBIS, and their interest in professional development to learn about PBIS. Our findings suggest that, although paraeducators valued involvement in PBIS, their overall level of involvement was low across most aspects. Common barriers included limited training and membership on PBIS teams, and paraeducators viewed in-district workshops and one-on-one coaching and mentoring as the most preferred approaches for learning about PBIS.

Effect of a Multifactorial Weight Loss Intervention on HDL Cholesterol Efflux Capacity and Immunosenescence: A Randomized Controlled Trial

Objective Life expectancy and obesity prevalence are increasing worldwide, leading to an increase in the prevalence of cardiovascular disease. High-density lipoprotein (HDL) functionality and immunosenescence play key roles in cardiovascular disease, longevity, and quality of aging. Both molecular hallmarks of aging are impacted by obesity and metabolic syndrome and can be modulated by lifestyle. We aimed to evaluate the effect of a lifestyle intervention focused on an energy-reduced Mediterranean diet (erMedDiet), physical activity (PA), and behavioral support on HDL cholesterol efflux capacity (CEC) and immunosenescence. Method CEC and immunosenescent T cells were determined in 60 participants from the control group (CG) and 56 from the intervention group (IG) of the PREDIMED-Plus trial at baseline and after 1 and 3 years of follow-up. PREDIMED-Plus is a randomized, controlled, parallel-group trial with an IG of erMedDiet, PA promotion, and behavioral support for weight loss and a CG of usual primary care advice. The sample included 116 volunteers from the PREDIMED-Plus-IMDEA subsample of the PREDIMED-Plus trial. Men aged 55 to 75 years and women aged 60 to 75 years with a body mass index between 27 and 40 kg/m2 and metabolic syndrome were included. Results Participants within the IG had significantly improved CEC (2.42% and 10.69% after 1 and 3 years of follow-up) and a decreased in senescent T cell profile (−3.32% ± 12.54% and −6.74% ± 11.2%, p < 0.001, after 1 and 3 years of follow-up). Baseline obesity status impacted the response to the intervention. Conclusions A weight loss intervention program with erMedDiet and PA ameliorated senescence markers.

Supporting traceability and biosecurity in the sheep and goat industries in NSW: understanding barriers to implementing electronic identification.

Efficient traceability is paramount for Australia's biosecurity system and market access. Electronic identification (eID) offers higher traceability performance than that achieved with visual and mob-based identification used for the sheep and goats National Livestock Identification System (NLIS). The current study aims to gain an understanding of the barriers and motivations of using eID for NLIS sheep and goats in New South Wales (NSW) and to provide recommendations to support the transition to eID. A social research study using a mixed-methods approach was used through semi-structured interviews and a cross-sectional epidemiological and behavioural study among sheep and goat producers. The COM-B behaviour change model based on capabilities, opportunities and motivations was used as a framework for the study. A total of 269 participants informed this study: 25 interviews were conducted with government, industry and private stakeholders, and 184 and 58 sheep and goat producers participated in the cross-sectional study, respectively. The study identified poor understanding of the purpose and importance of NLIS among producers, with over two-thirds not supporting eID implementation. The main barriers identified to the eID implementation were practical, including costs, technology quality and increased workload. Attitudinal, behavioural and knowledge barriers, such as the perception of the current system providing efficient traceability and the perceived lack of benefits of eID were also identified. This study provides an in-depth analysis of practices and perceptions of stakeholders and producers on sheep and goat traceability and recommendations to address barriers identified, based on education and appropriate behavioural and technical support.

Residents’ behavioral support for tourism in a burgeoning rural destination

This study aimed to test a model derived from the social exchange theory and the theory of planned behavior in determining the role that antecedents play in explaining residents' behavioral support for tourism in a rapidly developing destination. Data were collected from 511 residents of McCurtain County in Oklahoma, USA, using onsite interception and online sampling strategies. Based on a two-step structural equation modeling analysis, eight out of the 10 proposed hypotheses were supported. Of the four potential predictors of residents’ attitudinal support for tourism, perceived benefits, perceived costs, and trust in local government were significant, explaining 63% of the variance in the construct. Attitudinal support, subjective norms, and perceived behavioral control then significantly explained 84% of the variance in behavioral intentions to support tourism. These intentions, in turn, significantly explained 44% of the variance in behavioral support for tourism. Implications, limitations, and future research suggestions are discussed at the close of the article. Management ImplicationsResidents' support for tourism within McCurtain County in Oklahoma, USA, is not very strong mostly because residents do not feel that they can trust the government in making decisions regarding tourism and that they have limited power to contribute to tourism planning and management. To address the lack of trust in government, efforts should be made to increase transparency in tourism decision-making. This could occur through the greater inclusion of residents in planning sessions and sharing reports with the public (e.g., sharing minutes and reports via websites, radios, newspapers, etc.). The government should find ways to include more residents in tourism-related decision-making that will affect not only tourism businesses but also the community as a whole. This could look like a regular assessment of residents’ perspectives through conducting surveys, holding focus group interviews, or hosting town hall meetings.

Russia’s Autocratic Resilience and the Sources of Political Change: Lankina’s Estate Origins

In Estate Origins, Tomila Lankina sheds new light on the logic of persistence and resilience in the Russian social structure that shapes political possibilities in Russia to the present day. It is a wonderful and rewarding read on the historical origins of social requisites of democracy, such as greater civic activism and more pluralistic political competition. To understand variation in attitudinal and behavioral support for democracy in contemporary Russia, according to Lankina, we must go back to tsarist Russia’s estate institutions. A set of institutions that codified the rights and privileges of different social groups, the estates system created incentives for an eclectic and growing stratum of urban dwellers known as meshchane to invest in education while simultaneously fostering the creation of institutional “infrastructures”—professions, educational institutions, charitable, civic, and local governance bodies—that retained during the communist period a degree of autonomy vis-à-vis the state. This, Lankina argues, allowed the meshchane’s distinct value orientations to persist over time.

Complexity of patient encounters within a clinically integrated community pharmacy network Medicaid payer program

BackgroundCommunity pharmacists frequently care for patients with complex medical and social needs; however, specific evidence on pharmacist perceptions of what makes a patient encounter complex has not been clearly characterized. There is a need to better understand specific factors that contribute to patient encounter complexity and demonstrate how pharmacists in community settings care for these individuals. ObjectivesThe objectives of this programmatic case study were to: (1) elucidate factors that contributed to patient encounter complexity as a part of a Medicaid Managed Care Organization comprehensive medication management payer program in community pharmacies and (2) curate a series of patient case vignettes that provide evidence of pharmacists care for patients with complex medical and social needs within community pharmacies. MethodsThis qualitative programmatic case study utilized data from semistructured interviews with community pharmacists who provided comprehensive medication management services to Medicaid patients in Pennsylvania. Pharmacists described their most complex patient encounter. Interviews were transcribed and independently coded by 2 investigators. The coded texts were grouped into categories, and a cross-case inductive thematic analysis was performed to identify complexity factors. ResultsThirty pharmacists provided 48 patient case vignettes and 3 complexity factors emerged: (1) care coordination, (2) behavioral health support, and (3) social determinants of health. Representative patient case vignettes were selected to illustrate these factors. ConclusionPharmacists, who participated in a community pharmacy Medicaid Managed Care Organization payer program, provided care to patients with complex health needs. In addition to medication-related problems, specific factors that increased pharmacist perception of encounter complexity were care coordination with other health care providers, behavioral health support, and addressing social determinants of health.

Positive behavior support in school – a quasi-experimental mixed methods study and a randomized controlled trial

BackgroundWhile positive school climate is important for students’ well-being and mental health, school personnel may experience challenges in creating a nurturing school climate. School-Wide Positive Behavioral Interventions and Supports (SW-PBIS) has shown positive effects on school climate and children’s prosocial behaviors, but fewer studies have been conducted in a European context.AimThis project aims to investigate the effectiveness of SW-PBIS program for students’ social-emotional skills and academic achievement as well as teachers’ and students’ perceptions of classroom learning environment. Furthermore, the study intends to evaluate how school-level factors mediate or moderate the effects of the intervention. In addition, the study includes a qualitative evaluation of the dynamic interaction processes that occur during program implementation in local school contexts.MethodsData on school- and individual-level measures are collected in intervention and control schools. With regard to challenges in retaining control groups over extended time periods, two waves of recruitment are used. In the first wave, an active control group is used and data are collected during three time points. In the second wave, a wait-list control group will be used and data will be collected during two time points during one school year. Hierarchical regression analyses will be conducted to explore the effects of SW-PBIS on the outcomes of the study. An ethno-methodological approach will be applied to provide a detailed examination of the social interactional and meaning-making practices of different school implementation teams, and the negotiation of normative expectations and rules of conduct in peer-teacher-student interactions in different classrooms.DiscussionThe study is expected to contribute to knowledge on the effects of the SW-PBIS program and how these effects may be mediated or moderated by school-level factors. Combining quantitative and qualitative methods to explore the significance of school contexts in the implementation of the SW-PBIS program constitutes the strength of the study. The challenge in the study is the extended period of implementation of SW-PBIS, which entails difficulties in retaining a control group over the required time period. Therefore, two waves of recruitment are used, encompassing different procedures of allocation to intervention or control group.Trial registrationClinicalTrials.gov Identifier: NCT06270914 on the 22nd of February, 2024 (retrospectively registered).

Evaluating Experiences in a Digital Nutrition Education Program for People With Multiple Sclerosis: A Qualitative Study.

Multiple sclerosis (MS) is a complex immune-mediated disease with no currently known cure. There is growing evidence to support the role of diet in reducing some of the symptoms and disease progression in MS, and we previously developed and tested the feasibility of a digital nutrition education program for people with MS. The aim of this study was to explore factors that influenced engagement in the digital nutrition education program, including features influencing capability, opportunity and motivation to change their dietary behaviours. Semi-structured interviews were conducted with people who had MS, and who completed some or all of the program until data saturation was reached. Interviews were analysed inductively using thematic analysis. Themes were deductively mapped against the COM-B (Capability, Opportunity, Motivation, Behaviour) behaviour change model. Sixteen interviews were conducted with participants who completed all (n = 10) or some of the program (n = 6). Four themes emerged: (1) acquiring and validating nutrition knowledge; (2) influence of time and social support; (3) getting in early to improve health and (4) accounting for food literacy experiences. This is the first online nutrition program with suitable behavioural supports for people with MS. It highlights the importance of disease-specific and evidence-based nutrition education to support people with MS to make dietary changes. Acquiring nutrition knowledge, coupled with practical support mechanisms, such as recipe booklets and goal setting, emerged as crucial for facilitating engagement with the program. When designing education programs for people with MS and other neurological conditions, healthcare professionals and program designers should consider flexible delivery and building peer support to address the needs and challenges faced by participants. Members of the MS Nutrition Research Program Stakeholder Reference Group, which includes people with MS and MS health professionals, provided input during the development of the nutrition education program and study design stages.

Personalised Health Behaviour Support Programme in Adults With Post-COVID Syndrome: A Randomised, Controlled Pilot Feasibility Trial.

We investigated whether a novel 8-week personalised health behaviour support programme, focusing on the stability of symptoms and strategies to improve activities of daily living, was feasible and acceptable in adults with post-COVID syndrome. In this randomised, controlled, pilot feasibility trial, 32 adults with post-COVID syndrome (continued symptoms for ≥ 12 weeks) were randomised 1:1 to receive personalised health behaviour support (self-reported physical activity and symptom diaries, plus seven one-to-one remotely delivered personalised self-management support sessions), once weekly for 8-weeks, or usual care (referral to online 'your COVID-19 recovery' programme). The primary outcome was the feasibility of recruiting and randomising adults with post-COVID syndrome. The secondary outcomes were to assess the acceptability and safety of the intervention and various outcome measures. Of the 48 adults who expressed interest in the study, 32 (67%) were eligible and completed the baseline assessment. All 32 adults were willing to be randomised to either the personalised health behaviour support programme (n = 17) or usual care (n = 15) and 27 (age: 45 ± 12 years) adults completed follow-up at 9 weeks. The intervention was deemed feasible, with high adherence (92% and 94% completion rates for the physical activity and symptom diaries, respectively) and excellent acceptability rates (94% 'liked the intervention a lot'). The intervention was deemed safe, with no symptom exacerbations reported. An 8-week personalised health behaviour support programme was feasible for adults with post-COVID syndrome, with good adherence and acceptability rates. Early pilot data from this small sample also suggests meaningful improvements in physical activity, fatigue and respiratory symptoms. People living with post-COVID syndrome were involved from the outset with the study design, review of study documentation and interpretation of the data following completion. Furthermore, several participants have supported the local dissemination of findings following the completion of the study.

Employing a positive behaviour support approach on a neuro-behavioural ward: A service evaluation

Background:Outcomes from neuro-behavioural wards can be overlooked due to the complex and varied presentations and difficulty in establishing the ingredients contributing to functional improvements.Methods:A service evaluation was conducted on an adult Neuro-behavioural Rehabilitation Unit (NRU) at the Royal Hospital for Neuro-disability (RHN) (2015-2022). Primary aims were to examine demographic characteristics and assess the functional benefits of admission to a setting that utilises a positive behaviour support (PBS) approach as indicated by the Functional Independence Measure and Functional Assessment Measure (FIM+FAM) and Swansea Neurobehavioural Outcome Scale (SASNOS) scores.Results:The FIM+FAMs of 53 patients (38% female; mean age 44) were included. The majority of patients were White British (60%). Most patients were admitted to the NRU following a traumatic brain injury (TBI; 41%), and admission was, on average, seven months after their injury. The results show that the mean FIM+FAM score revealed significant statistical improvement from admission to discharge. Improvement is also seen in all domains and almost all sub-domains of the SASNOS.Conclusion:The findings support an association between admission to a neuro-behavioural rehabilitation setting providing PBS and improvements over time. Careful selection of outcome measures and consistent completion is necessary to support successful funding applications for neuro-behavioural rehabilitation services.

Effect of a Class-wide Positive Behavioral Support Professional Development Program on Classroom Management Skills and Teacher Efficacy

Effect of a Class-wide Positive Behavioral Support Professional Development Program on Classroom Management Skills and Teacher Efficacy

Early childhood teachers’ use of an FBA iOS app to support students who engage in challenging behaviour: a pilot study

ABSTRACT Early childhood teachers receive some training related to overall classroom management but report receiving little training and support when working with children who engage in challenging behaviour. To alleviate the barriers to supporting students who engage in challenging behaviour, it may be helpful to implement a technology tool that provides early childhood teachers with evidence-based prevention and intervention supports for their students. One such tool, the Family Behavior Support App (FBSApp), has been previously used with families of young children who engage in challenging behaviour. The FBSApp has been shown to be effective in increasing families’ use of strategies, but the effects of the app in educational settings are currently unknown. The purposes of this single-case study are to see if there is a functional relation between the use of the FBSApp-created behaviour plan and teachers’ use of function-based behaviour strategies, as well as teachers’ perceptions of the FBSApp.

Effect of psychological nursing intervention on anxiety level and quality of life in patients with gastrointestinal peptic ulcer.

Peptic ulcer is a common gastrointestinal disease, and psychological intervention has an important influence on its occurrence and development. To investigate the effect of psychological nursing intervention on the anxiety level and quality of life of patients with gastrointestinal peptic ulcers. Two groups of patients with peptic ulcer were selected from January to December 2012, with 60 cases in each group, and psychological nursing intervention and routine treatment were respectively performed. Psychological nursing interventions include cognitive behavioral therapy, psychological support and relaxation training. Self-rating anxiety scale (SAS) and quality of life questionnaire were used to evaluate the anxiety level and quality of life of patients before, during and after treatment. The SAS scores of the experimental group significantly decreased over the course of treatment, from 52.3 before treatment to 30.5 after treatment, while SAS scores of the control group did not change significantly. Meanwhile, the experimental group's quality of life score (SF-36) significantly improved over the course of treatment, from 65.2 to 85.2, while the control group remained stable. Further analysis showed that sex and age had no significant influence on the effect of psychotherapy. Both men and women, young and old, showed similar trends in anxiety relief and improved quality of life after treatment. Psychological nursing-based intervention program has a positive effect on the anxiety level and quality of life of patients with gastrointestinal peptic ulcer.

Analyzing Community-Based Support Requests Made by Black Families Raising Autistic Children.

Black families experience additional barriers to accessing autism-related supports compared to White families. Community organizations can help mitigate the negative impact of systemic inequities and lack of support that Black caregivers of autistic family members experience. Little is known about the types of support Black families seek from these organizations. Therefore, the purpose of this study was to explore the support needs of Black families raising autistic children as evidenced by communication patterns in a community-based statewide autism organization. Our research questions were: (1) What are the autism-related support needs of Black families raising autistic children; and (2) How do familial demographics influence these support needs? We explored the support needs of Black caregivers of autistic family members by analyzing a subset of 1,460 entries (16.8% of the total communication entries) within a database of communication entries from a community-based autism organization in one southeastern state in the United States. We analyzed the frequency of support request types and the relationships between support requests and familial demographics (i.e., rurality, gender, age). We found that Black families most often requested family or individual support, school-related support, and behavioral support. Families requested support with bullying, social services, and health insurance less often. We found significant interactions between the three most requested services and the rurality, gender, and age of the autistic family member. We conclude with suggestions for autism support organizations seeking to better meet the needs of Black families.

Resilience among older adults with multimorbidity using the Connor-Davidson scale in the Canadian Longitudinal Study on Aging: health behaviour, socio-economic, and social support predictors

ObjectiveMultimorbidity is recognized as a serious health condition faced by a majority of older adults. Research investigating adaptive responses to multimorbidity, termed multimorbidity resilience, has been growing. This paper examines protective and risk factors, with a focus on health behaviours, socio-economic resources, and social support using an established measure of resilience (Connor-Davidson Resilience Scale) among older adults, focusing on older persons with two or more concurrent chronic conditions.MethodsUsing Baseline (2011–2015), Follow-up One (2015–2018), and Follow-up Two (2018–2021) data from the Comprehensive Cohort of the Canadian Longitudinal Study on Aging, we tested hypotheses using 13,064 participants aged 65 years and older, who completed all waves and reported two or more of 27 chronic conditions, for the full sample of multimorbid individuals and three multimorbidity clusters: Cardiovascular/Metabolic, Musculoskeletal, and Mental Health. Associations between protective and risk factors and resilience were examined using linear regression to model the Connor-Davidson resilience scale, adjusting for illness context and social determinants of health.ResultsAmong all multimorbid individuals, the strongest associations with resilience were found for higher self-rated health, greater sleep satisfaction, better appetite, higher household income, more relatives and friends, being overweight (compared to normal weight), fewer housing problems, and fewer skipped meals. Weaker associations were found for non-smokers, less alcohol consumption, less pain, sedentary behaviour, being non-married (compared to married), and among Canadian born (compared to foreign). The analyses for the three multimorbidity clusters were largely replicated for the three multimorbidity clusters, but with some nuances depending on the cluster.DiscussionThis research provides confirmatory evidence for several protective and risk factors affecting the ability to cope and recover from multimorbidity adversity among older adults. There are consistent patterns for the multimorbidity disease clusters, but some distinct relationships arise that are worthy of attention. The implications of the findings for modifiable health behaviours and socio-economic factors are discussed for their public health and clinical relevance.

Oncologists’ communication about tobacco and alcohol use during treatment for esophagogastric cancer: a qualitative observational study of simulated consultations

PurposeTobacco and alcohol use influence cancer risk as well as treatment outcomes, specifically for esophageal and gastric cancer patients. Therefore, it is an important topic to discuss during consultations. This study aims to uncover medical, radiation, and surgical oncologists’ communication about substance use, i.e., tobacco and alcohol use, in simulated consultations about curative and palliative esophagogastric cancer treatment.MethodsSecondary analyses were performed on n = 40 standardized patient assessments (SPAs) collected in three Dutch clinical studies. Simulated patients with esophagogastric cancer were instructed to ask about smoking or alcohol use during treatment. The responses of the 40 medical, radiation, and surgical oncologists were transcribed verbatim, and thematic analysis was performed in MAXQDA.ResultsOncologists consistently advocated smoking cessation during curative treatment. There was more variation in their recommendations and arguments in the palliative compared to the curative setting and when addressing alcohol use instead of smoking. Overall, oncologists were less stringent regarding behavior change in the palliative than in the curative setting. Few oncologists actively inquired about the patient’s perspective on the substance use behavior, the recommended substance use change, or the support offered.ConclusionClear guidelines for oncologists on when and how to provide unequivocal recommendations about substance use behavior change and support to patients are needed. Oncologists might benefit from education on how to engage in a conversation about smoking or alcohol.

Relationship between Family Variables and Career Adaptability: A Meta-Analysis.

This study aimed to examine the relationship between family variables (i.e., family support, family SES, parental career-related behavior (PCB) support, PCB interference, and a PCB lack of engagement) and career adaptability through a meta-analysis. A systematic search for relevant studies was conducted using research databases. Twenty-four quantitative studies were yielded from 1684 records on the association between family variables and CA that were published between 1981 and 2024. Two researchers conducted data extraction independently, following coding standards. Comprehensive Meta-Analysis Version 3.3 was used in this study. The result showed that PCB support demonstrated a moderately significant correlation with CA and the largest effect size (r = 0.325). A non-significant result was found only for the correlation between PCB interference and CA. Except for gender, the moderating effects of region, age, CA measure, and publication year were found in the relationship between some family variables and CA. One limitation is the restricted range of the samples due to few studies investigating samples from regions other than Asia. The findings can highlight future directions for family studies and career research and hold practical implications for institutes, companies, and communities related to career development. This study was registered in the Open Science Framework (10.17605/OSF.IO/76HNQ).

Prospective associations between early childhood mental health concerns and formal diagnosis of neurodevelopmental disorders in adolescence.

Understanding associations between psychosocial development in early childhood and formal diagnosis of neurodevelopmental disorders (NDDs) in adolescence is critical for early identification and for tailoring interventions and support. This study investigated whether the Strengths and Difficulties Questionnaire (SDQ) scores in early childhood (4-5 years) predict mental health (MH) problems as evidenced by SDQ scores and formal diagnosis of NDDs in adolescence (16-17 years). This study analysed data from a sample of 4968 children and adolescents using data from the Longitudinal Study of Australian Children. We used hierarchical regression models to determine the association between SDQ subscales and total scores at ages 4-5 years (primary exposure) and total SDQ scores and NDD diagnoses at ages 16-17 years (outcomes) whilst controlling for sociodemographic risk factors. Each unit increase in SDQ score at age 4-5 led to a rise in SDQ scores at age 16-17. Autism and ADHD diagnoses, female gender, lower maternal education, and financial hardship were associated with higher SDQ scores at age 16-17. Furthermore, parent reported SDQ at age 4-5 was linked to higher likelihoods of formal diagnoses of ADHD, autism, and ADHD/autism at age 16-17. Additionally, social determinants of health such as female gender, culturally and linguistically diverse (CALD) backgrounds, and financial hardship were associated with increased odds of ADHD, autism, and ADHD/autism diagnoses at age 16-17. Our findings highlight the opportunity for early identification of transdiagnostic developmental and MH issues in the preschool period. Findings also emphasise the critical role of social determinants of health in the longitudinal trajectory of MH and NDDs and highlight the need for implementing early supports for improving peer relations and behavioural support strategies. If coupled with wrap around social care, early support strategies can enhance MH and wellbeing in adolescence and beyond.