Multicomponent Treatment Package Research Articles

Using Augmented Reality and Modified Schema-Based Instruction to Teach Problem Solving to Students With Autism

Young adults with autism spectrum disorder (ASD) need both academic and social skills required to apply acquired knowledge and skills in real-world settings. This study evaluated the effects of a multicomponent intervention incorporating both Modified Schema-Based Instruction (MSBI) and video-based instruction delivered via augmented reality (AR) to teach the social and mathematical problem-solving skills needed to execute personal finance tasks in the community. Participants were four 21-year-old young adults with ASD enrolled in a public school transition program located on the campus of a technical college. Findings of the single-case multiple probe across participant design support a functional relationship between the multicomponent treatment package and the social and mathematical problem-solving skills of the young adults with ASD. Furthermore, participants were also able to self-correct errors after watching AR-triggered model videos. Generalization to a novel setting was tested. Results, implications, and suggestions for future research are discussed

The Therapy Box in the Classroom: A Function-based Multi-Component Directive Play Therapy Treatment Package Intervention

The Therapy Box in the Classroom: A Function-based Multi-Component Directive Play Therapy Treatment Package Intervention

Contextualizing Mathematical Problem-Solving Instruction for Secondary Students with Extensive Support Needs: A Systematic Replication

Replication research provides evidence to establish, refute, or support evidence-based practices. Systematic replications are also necessary to determine “what works for whom when.” The purpose of this study was to conduct a conceptual systematic replication to evaluate the effectiveness of a multicomponent treatment package on multiplicative problem solving for middle school students with extensive support needs. Using a modified schema-based instructional strategy, three participants were taught to solve percent of change problems contextualized in real-world scenarios and a purchasing strategy (i.e., next-dollar strategy) to help them determine how much money was needed to pay for services/products. In addition, goal-setting and self-graphing activities supported development of self-determination skills. Findings from the multiple probe across participant design demonstrate a functional relation between the intervention and independent problem-solving behaviors of all three participants. Students also generalized problem-solving behaviors when presented with real-world stimuli of coupons and receipts. Implications for practice and future research are discussed.

Countering emotional behaviors in the treatment of borderline personality disorder.

The purpose of the current study was to investigate the unique effects of a commonly used skill incorporated into treatment packages for borderline personality disorder (BPD), countering emotion-driven behavioral urges. Individuals with BPD (N = 8) participated in a single-case experimental design, specifically a multiple baseline, in which they were randomly assigned to complete a baseline assessment-only phase of 2 or 4 weeks. Participants then received four sessions of the countering emotional behaviors module from the unified protocol, followed by a 4-week follow-up phase. Throughout the duration of the study, daily data capture was used to assess real-time changes in the frequency of emotionally avoidant behaviors in response to emotional experiences. Symptoms of BPD, depression, and anxiety were also assessed. By follow-up, the majority of patients demonstrated a meaningful reduction (per single-case experimental design guidelines for evaluating improvements) in their use of avoidant behaviors. There was also preliminary evidence that encouraging participants to act counter to avoidant urges is associated with decreases in BPD, depression, and anxiety symptoms, as well as negative affectivity. The countering emotional behaviors skill from the unified protocol indeed engages its putative target of emotionally avoidant behavioral coping, indicating it is an active ingredient in multicomponent treatment packages for BPD, with implications for downstream clinical endpoints such as BPD and depressive and anxiety symptoms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Using the Preparation Phase of the Multiphase Optimization Strategy to Develop a Messaging Component for Weight Loss: Formative and Pilot Research.

BackgroundMobile messaging is often used in behavioral weight loss interventions, yet little is known as to the extent to which they contribute to weight loss when part of a multicomponent treatment package. The multiphase optimization strategy (MOST) is a framework that researchers can use to systematically investigate interventions that achieve desirable outcomes given specified constraints.ObjectiveThis study describes the use of MOST to develop a messaging intervention as a component to test as part of a weight loss treatment package in a subsequent optimization trial.MethodsOn the basis of our conceptual model, a text message intervention was created to support self-regulation of weight-related behaviors. We tested the messages in the ENLIGHTEN feasibility pilot study. Adults with overweight and obesity were recruited to participate in an 8-week weight loss program. Participants received a commercially available self-monitoring smartphone app, coaching calls, and text messages. The number and frequency of text messages sent were determined by individual preferences, and weight was assessed at 8 weeks.ResultsParticipants (n=9) in the feasibility pilot study lost 3.2% of their initial body weight over the 8-week intervention and preferred to receive 1.8 texts per day for 4.3 days per week. Researcher burden in manually sending messages was high, and the cost of receiving text messages was a concern. Therefore, a fully automated push notification system was developed to facilitate sending tailored daily messages to participants to support weight loss.ConclusionsFollowing the completion of specifying the conceptual model and the feasibility pilot study, the message intervention went through a final iteration. Theory and feasibility pilot study results during the preparation phase informed critical decisions about automation, frequency, triggers, and content before inclusion as a treatment component in a factorial optimization trial.Trial RegistrationClinicalTrials.gov NCT01814072; https://clinicaltrials.gov/ct2/show/NCT01814072

The Effect of Systematic Prompting on the Acquisition of Two Muscle-Strengthening Exercises by Adults with Moderate Disabilities.

Musculoskeletal fitness is important for adults with intellectual disabilities (ID) to maintain cardiovascular fitness, functional independence, and work task performance, and to reduce the risk of chronic diseases and other disabilities. However, adults with ID typically have significantly lower musculoskeletal fitness compared with their peers without a disability. Appropriate instructional strategies are needed to facilitate their acquisition and maintenance of musculoskeletal fitness. In this study, three adults with moderate ID, aged 19-20 years, were selected to evaluate the effects of a multi-component treatment package that included a video-enhanced system of least-to-most prompts (LMP) on their acquisition of two muscle-strengthening machine exercises. Results from a multiple-baseline-across-participants single-subject design show substantive gains in correct and independent performance of steps in the two exercises during the treatment condition. The improved performance in both exercises was maintained one week and two weeks after the last treatment session and appeared to have extended to a large fitness room. The study suggests that use of the video-enhanced system of LMP as an additional or alternate type of instruction can lead to improved acquisition and maintenance of muscle-strengthening exercises by young adults with moderate ID.

Improving access to specialized care for first-episode psychosis: an ecological model.

Psychotic spectrum disorders are serious illnesses with symptoms that significantly impact functioning and quality of life. An accumulating body of literature has demonstrated that specialized treatments that are offered early after symptom onset are disproportionately more effective in managing symptoms and improving outcomes than when these same treatments are provided later in the course of illness. Specialized, multicomponent treatment packages are of particular importance, which are comprised of services offered as soon as possible after the onset of psychosis with the goal of addressing multiple care needs within a single care setting. As specialized programs continue to develop worldwide, it is crucial to consider how to increase access to such specialized services. In the current review, we utilize an ecological model of understanding barriers to care, with emphasis on understanding how individuals with first-episode psychosis interact with and are influenced by a variety of systemic factors that impact help-seeking behaviors and engagement with treatment. Future work in this area will be important in understanding how to most effectively design and implement specialized care for individuals early in the course of a psychotic disorder.

A comparison of two multicomponent treatment packages for food refusal

Food refusal is a severe feeding problem in which children refuse to eat all or most foods, which can be treated effectively using multicomponent intervention packages. This study compared two multicomponent treatment packages on food and drink consumption, inappropriate mealtime behavior, and total intake in a child with food refusal. Bite and drink consumption was consistently higher; inappropriate mealtime behavior was consistently lower; and total intake was greater when differential reinforcement of alternative behavior and escape extinction treatment were implemented compared to response cost, escape extinction, and differential reinforcement of alternative behavior.

Optimizing psychosocial interventions in first-episode psychosis: current perspectives and future directions.

Psychotic-spectrum disorders such as schizophrenia, schizoaffective disorder, and bipolar disorder with psychotic features are devastating illnesses accompanied by high levels of morbidity and mortality. Growing evidence suggests that outcomes for individuals with psychotic-spectrum disorders can be meaningfully improved by increasing the quality of mental health care provided to these individuals and reducing the delay between the first onset of psychotic symptoms and the receipt of adequate psychiatric care. More specifically, multicomponent treatment packages that 1) simultaneously target multiple symptomatic and functional needs and 2) are provided as soon as possible following the initial onset of psychotic symptoms appear to have disproportionately positive effects on the course of psychotic-spectrum disorders. Yet, despite the benefit of multicomponent care for first-episode psychosis, clinical and functional outcomes among individuals with first-episode psychosis participating in such services are still suboptimal. Thus, the goal of this review is to highlight putative strategies to improve care for individuals with first-episode psychosis with specific attention to optimizing psychosocial interventions. To address this goal, we highlight four burgeoning areas of research with regard to optimization of psychosocial interventions for first-episode psychosis: 1) reducing the delay in receipt of evidence-based psychosocial treatments; 2) synergistic pairing of psychosocial interventions; 3) personalized delivery of psychosocial interventions; and 4) technological enhancement of psychosocial interventions. Future research on these topics has the potential to optimize the treatment response to evidence-based psychosocial interventions and to enhance the improved (but still suboptimal) treatment outcomes commonly experienced by individuals with first-episode psychosis.

Early Intervention in Psychosis in the United States

Available data have demonstrated the clinical benefits and cost-effectiveness of multi-component treatment packages for individuals early in the course of psychotic-spectrum disorders. In response, an unprecedented effort aims to disseminate such multi-component treatment programs—referred to as Coordinated Specialty Care (CSC)—throughout the United States. We review the evidence in support of CSC care for first-episode psychosis and highlight specific policy reforms that may facilitate the successful dissemination and eventual improvement of CSC programs for first-episode psychosis. Among proposed reforms are novel financing strategies for CSC services and incentivizing of continued collaboration between academic and community agencies to facilitate sustained dissemination and refinement of CSC.

Effects of Antecedent Manipulations and Social Reinforcement to Increase Lateral Positioning in a Premature Infant with Obstructive Sleep Apnea.

Recent research suggests supine positioning for sleeping infants is the safest position to prevent breathing related difficulties; however doing so can significantly increase obstruction in apneic infants resulting in decreased sleep quality. We implemented a multi-component treatment package compromised of antecedent interventions and parent-mediated social reinforcement to increase lateral positioning in a premature infant with obstructive sleep apnea. Results indicate that the intervention increased lateral positioning in the participant by over 80% in the final phase of the study, indicating efficacy of the intervention. Limitations and suggestions for future research are discussed.

The Early Psychosis Intervention Center (EPICENTER): development and six-month outcomes of an American first-episode psychosis clinical service.

BackgroundThere is growing evidence that specialized clinical services targeted toward individuals early in the course of a psychotic illness may be effective in reducing both the clinical and economic burden associated with these illnesses. Unfortunately, the United States has lagged behind other countries in the delivery of specialized, multi-component care to individuals early in the course of a psychotic illness. A key factor contributing to this lag is the limited available data demonstrating the clinical benefits and cost-effectiveness of early intervention for psychosis among individuals served by the American mental health system. Thus, the goal of this study is to present clinical and cost outcome data with regard to a first-episode psychosis treatment center within the American mental health system: the Early Psychosis Intervention Center (EPICENTER).MethodsSixty-eight consecutively enrolled individuals with first-episode psychosis completed assessments of symptomatology, social functioning, educational/vocational functioning, cognitive functioning, substance use, and service utilization upon enrollment in EPICENTER and after 6 months of EPICENTER care. All participants were provided with access to a multi-component treatment package comprised of cognitive behavioral therapy, family psychoeducation, and metacognitive remediation.ResultsOver the first 6 months of EPICENTER care, participants experienced improvements in symptomatology, social functioning, educational/vocational functioning, cognitive functioning, and substance abuse. The average cost of care during the first 6 months of EPICENTER participation was lower than the average cost during the 6-months prior to joining EPICENTER. These savings occurred despite the additional costs associated with the receipt of EPICENTER care and were driven primarily by reductions in the utilization of inpatient psychiatric services and contacts with the legal system.ConclusionsThe results of our study suggest that multi-component interventions for first-episode psychosis provided in the US mental health system may be both clinically-beneficial and cost-effective. Although additional research is needed, these findings provide preliminary support for the growing delivery of specialized multi-component interventions for first-episode psychosis within the United States.Trial registrationClinicalTrials.gov Identifier: NCT01570972; Date of Trial Registration: November 7, 2011

A Treatment Package without Escape Extinction to Address Food Selectivity.

Feeding difficulties and feeding disorders are a commonly occurring problem for young children, particularly children with developmental delays including autism. Behavior analytic interventions for the treatment of feeding difficulties oftentimes include escape extinction as a primary component of treatment. The use of escape extinction, while effective, may be problematic as it is also associated with the emergence of challenging behavior (e.g., extinction burst). Such challenging behavior may be an acceptable side effect in treatment cases where feeding problems are severe and chronic (e.g., failure to thrive). However, in more acute cases (e.g., selective eating), the negative side effect may be unwarranted and undesired. More recent research on the behavioral treatment of food selectivity has begun to evaluate treatments for feeding difficulties that do not include escape extinction (e.g., demand fading, behavioral momentum), with some success. However, research to date reveals individual differences in responsiveness to such treatments and no clear preferable treatment has emerged. This manuscript describes a multi-component treatment package that includes shaping, sequential presentation and simultaneous presentation, for the treatment of food selectivity in four young children with developmental delays. This treatment package extends the literature on the behavioral treatment for food selectivity and offers a multi-component treatment protocol that may be clinically applicable across a range of treatment scenarios and settings.

Parent-Assisted Cognitive-Behavioural Therapy for Children's Nighttime Fear

Nighttime fear, including fear of monsters and the dark, is common. For most children and adolescents, nighttime fears are transient. However, approximately 10% experience severe nighttime fear that negatively impacts sleep, adjustment, and family life. Research conducted in the 1980s indicates that cognitive-behavioural therapy can reduce nighttime fear in as few as three sessions. The aims of the present study were to replicate and extend earlier research by evaluating a cognitive-behavioural treatment package for children's severe nighttime fear, and address methodological issues in previous studies. A manualised, multi-component treatment package was developed, based on current evidence-based practice for the treatment of children's anxiety. Interventions included graded exposure, muscle relaxation, cognitive restructuring, and social and material reinforcement. Treatment was individually tailored and delivered via weekly modules. A multiple baseline across-subjects design was utilised. Four ‘families’ — one parent and one child — participated; children's ages ranged from 6 to 10 years. Families attended five weekly intervention sessions and a 1-month follow-up. Multiple outcome measures were administered pre- and post-treatment. All children displayed changes consistent with reduced nighttime fear following treatment, including fewer phobic symptoms, reduced general fear, and improved nighttime and general behaviour. These changes were maintained at follow-up. Parents reported a high degree of satisfaction with the program and would recommend it to other families. The results support the effectiveness of manualised, parent-assisted treatment for nighttime fear in as few as three sessions. In cases of severe nighttime fear, therapist support is recommended. Treatment implications for children with complex presentations are discussed.

Increasing In-School Food Consumption of an Elementary Student with Emotional/Behavioral Disorders: A Case Study

Researchers conducted the present case study to address the immediate need of a student who consumed food at home and refused all food and liquids in her elementary school setting. In order to increase in-school food consumption, researchers developed a multicomponent treatment package that included antecedent adjustments (time and place food was offered), contingent reinforcement (access to highly preferred item following consumption of less preferred food item), and shaping procedures to adjust the weight of highly preferred and less preferred food items. Food consumption increased from 0% food consumed during baseline sessions to 100% of food items consumed during intervention sessions. Food consumption generalized to snack time and later to lunch. Follow-up data collected during three weeks postintervention demonstrated the student continued to consume her entire lunch during lunchtime.

Social Cognition Training for Individuals with Schizophrenia: Emerging Evidence

Growing evidence indicates that social cognitive deficits are important, unique determinants of poor functional outcome in schizophrenia. These findings have generated considerable interest in the possibility of intervening at the level of social cognition as a means of improving functional outcome. In this review article, we first briefly describe the major domains of social cognition that have been studied in schizophrenia and their functional relevance for people with this disorder. We then review and critically evaluate recent studies that examined the modifiability of social cognition in schizophrenia through psychosocial interventions, including brief experimental manipulations, longer-term studies that embed social cognitive training in broad, multicomponent treatment packages, and longer-term treatment studies that specifically target social cognitive skills. Emerging evidence indicates that performance on social cognitive tasks is amenable to commonly used intervention techniques and that broad a...

Habit Reversal Training for Tic Disorders in Children and Adolescents

Chronic tic disorders, including Tourette's syndrome (TS), affect approximately .5% of children and adolescents. Although strong evidence exists supporting a neurobiological etiology, operant factors may play a role in the maintenance of tic behaviors. Pharmacological approaches remain the most commonly used intervention for chronic tic disorder in children and adults. Nevertheless, the unpredictable efficacy and serious side effects associated with medication along with parental concerns about long-term medication use in children underlie the need for nonpharmacological interventions for tics in this age group. This article reviews the rationale and evidence base for the use of habit reversal training (HRT), a multicomponent behavioral treatment package, as a treatment for childhood tics. Each of the primary treatment components of HRT is described and implementation is illustrated in case report format. A growing body of data suggests that HRT is a well-tolerated and efficacious intervention for tic disorders in this age group.

A Multicomponent Treatment Package to Increase Anger Control in Teacher-Referred Boys

ABSTRACT A manualized treatment package for anger control in boys ages 7 to 10 was investigated using a control group outcome design. The treatment package included modeling, rehearsal with self-talk problem-solving, daily report cards and a praise phase. At post-test treatment participants were significantly higher than controls on the Aggression Control factor of the Olweus Aggression Inventory (OAI) and the Compliment observation category. Control's scores were significantly higher than the treatment group's on the Dislike Factor of the Peer Status Rating Scale-Child Report Form and on the Threat observation category.

Treatment of chronic food refusal in a young developmentally disabled child

Chronic food refusal is a common problem among young children with developmental disabilities. Children with chronic food refusal may require supplemental tube feedings or parental feedings. A multicomponent treatment package consisting of escape–avoidance extinction, shaping and positive reinforcement was effective in establishing a normal oral feeding pattern with a 1.5 years old developmentally disabled child who was fed by gastrostomic tube. Treatment effects generalized to the home setting and were maintained during follow-up. After treatment, tube-feeding was discontinued. Copyright © 1999 John Wiley & Sons, Ltd.

The effects of implementing program consequences with a group of individuals who engaged in sensory maintained hand mouthing

This study evaluated whether a multicomponent treatment package could be successfully implemented with individuals who engage in self-injurious hand mouthing maintained by sensory consequences in the context of both individual and small group settings. Three ambulatory individuals with profound mental retardation participated on an individual basis followed by treatment within a group setting. Generalization of the intervention results to the natural living environment was then analyzed. Using an ABAB experimental design, the effectiveness of brief response interruption followed by the introduction of a preferred leisure item to reduce hand mouthing during 15-min intervention sessions was analyzed. Results of these experiments showed that the intervention could be successfully implemented during individual and small group sessions and during group sessions conducted in the natural environment. The benefits and limitations of this intervention strategy and future research are discussed.