Treatment Acceptability Ratings Research Articles

Training support persons to help smokers quit: A pilot study

Background Evaluate the feasibility, acceptability, and potential efficacy of a skills-training intervention for adults interested in helping someone to stop smoking (i.e., support persons). Methods Sixty adult support persons (77% female) were directly recruited from the community and randomly assigned to this intervention (manual plus five weekly group-based sessions) or a control condition (one-page leaflet). All intervention and outcome assessments occurred through the support persons. Assessments occurred at weeks 0 (baseline), 6 (end of treatment), 12, and 24. The study was conducted from 1998 to 2001; data collection occurred from 1999 to 2000. Outcomes were ratings of treatment acceptability, recruitment and retention rates, supportive behaviors provided to the smoker, and smoking behavior change in the smoker as reported by the support person. Results Support persons were recruited in a timely manner and study retention rates were high. Support persons in skills training showed significant increases in their supportive behavior scores compared with control subjects at weeks 6 and 12. Although not statistically significant, the skills-training intervention was associated with more quit attempts, greater improvement in stage of change, and higher 7-day point prevalence abstinence rates in the smokers than the control condition. Conclusions A skills training intervention for support persons is feasible and acceptable. Further studies are needed to test the efficacy of this approach for smoking cessation.

Behavior Change and Perceptions of Change: Evaluating the Effectiveness of a Token Economy

ABSTRACT Token economies often reduce problematic classroom behavior in preschool settings. In the present study, direct observation and teacher ratings of child behavior and treatment acceptability were utilized to evaluate the effectiveness of a token economy in a Head Start classroom. Because many teachers express concerns about the effort required to implement and maintain token systems, this study compared the relative efficacies of group and individualized contingency management programs. Direct observation data for three children revealed that both the individual and group contingency were superior to a baseline condition in which no systematic behavior management program was utilized. In addition, the whole group contingency was generally as effective as the individual contingency. However, despite reductions in classroom rule violations for the three target children, the acceptability of the token program was variable and little change was observed in the teacher's ratings of their behavior. The results suggest the ongoing need for multiple measures of treatment outcome (e.g., teacher and student ratings of acceptability and effectiveness, direct observation) even for empirically supported school-based interventions.

Parent involvement and reading: Using curriculum‐based measurement to assess the effects of paired reading

AbstractThis study examined the effectiveness of a paired reading intervention using curriculum‐based measurement (CBM) probes to document reading progress for one fourth‐ and two third‐grade students. These students were considered below‐average readers. Parents and children used the paired reading method in their homes for 10 minutes, four times a week. Children and parents were also provided with reading material at their instructional level. Results showed that the children's reading accuracy and rates increased from baseline to follow‐up on CBM measures and on pre/posttesting. In addition, students and parents gave favorable treatment acceptability ratings for paired reading. Implications for future research are outlined. © 2003 Wiley Periodicals, Inc. Psychol Schs 40: 613–626, 2003.

A mand analysis and levels treatment in an outpatient clinic

AbstractAn adolescent with severe mental retardation and fragile X syndrome who displayed destructive behavior maintained by positive reinforcement in the form of adult compliance with mands was assessed and treated in an outpatient setting. A levels system treatment was assessed, consisting of a continuum of attention and reinforcement ranging from access to the functional reinforcer in level 3 contingent upon appropriate behavior to a 10 min room time‐out for level 1 contingent upon aggressive and dangerous behavior. While the efficacy of this treatment has been demonstrated in an inpatient setting (Hagopian et al., 2002), this application extended the findings to outpatient and community settings. The levels system treatment resulted in a 98.1% reduction in destructive behavior from baseline levels. Treatment was successfully transferred to the home and school and reductions were maintained at 6 and 9 months. Treatment acceptability ratings were high across both home and school staff. Copyright © 2003 John Wiley & Sons, Ltd.

Investigating the acceptability of behavioral interventions in applied conjoint behavioral consultation: Moving from analog conditions to naturalistic settings.

Whereas there exists a vast literature investigating consumer satisfaction ratings of various behavioral interventions, the majority of these studies have been limited to analogue conditions, which may compromise utility and generalization. Ad- ditionally, most research has failed to explore multiple-source, multiple-setting data in the investigation of treatment acceptability. This study investigated parent, teacher, and child treatment acceptability ratings derived from fi eld-based conjoint behavioral consultation cases. Data indicate that overall, parents, teachers, and children rated con- joint behavioral consultation-based behavioral interventions as very to highly accept- able. For parents, interventions with a reductive component were rated as more accept- able than interventions using both positive and negative components; no signifi cant differences were found among teacher and child group ratings. For teachers, there was a positive relationship between (a) intervention complexity and treatment acceptability ratings and (b) problem severity ratings and treatment acceptability ratings. Addition- ally, regression analyses indicate that for teachers, the interaction of complexity and problem severity signifi cantly predicted teacher treatment acceptability ratings, with teacher severity ratings demonstrating greater predictive validity. Implications of these fi ndings and directions for future research are explored.

The Effect of Child Characteristics on Teachers' Acceptability o f Classroom-Based Behavioral Strategies and Psychostimulant Medication for the Treatment of ADHD

Studied the effect of student characteristics on teachers' ratings of treatment acceptability for attention deficit hyperactivity disorder (ADHD). Participants (N = 159) included experienced elementary school teachers who read 1 of 6 vignettes describing a child with symptoms representative of ADHD. Vignettes varied by sex and symptom-subtype classification. However, the number and specific type of symptoms described in the vignettes were consistent across all conditions. Next, teachers read a description of a daily report card (DRC), response cost technique, classroom lottery, and medication and rated their levels of agreement to the items of the Behavioral Intervention Rating Scale (BIRS). Teachers preferred the DRC to all other forms of treatment. However, there was a significant interaction between the type of treatment and sex of the student on the 3 factors (Treatment Acceptability, Treatment Effectiveness, and Timeliness) of the BIRS.

Teaching Middle School Students with Learning Disabilities to Solve Word Problems Using a Schema-Based Approach

The present study investigated the effectiveness of a schema strategy on the mathematical word-problem-solving performance of 4 sixth- and seventh-grade students (2 girls, 2 boys) with learning disabilities. A multiple-baseline design across students and across two behaviors was used. Results indicated that the schema strategy led to an increase in word-problem-solving performance for all 4 students. Further, these results were maintained at a 2 and 4 weeks follow-up, and all 4 students' performance on two-step word problems (M = 86% correct) at the end of the study surpassed that of the normative sample (M = 54% correct). Student treatment acceptability ratings revealed that the strategy was helpful in solving word problems.

Effects of professional group membership, intervention type, and diagnostic label on treatment acceptability

Differences in ratings of treatment acceptability among groups of individuals who are often involved in the recommendation, selection, implementation, and evaluation of behavioral interventions in educational settings were examined. Teachers, school psychologists, and school social workers were presented with a vignette of a 3rd grade student exhibiting a pattern of disruptive problem behavior. The vignette was held constant but diagnostic labels (LD, BD, ADD) and interventions (verbal praise and token economy program versus time out from reinforcement program and verbal praise) for the child in the vignette were varied. After examining the vignette, participants rated the acceptability of the interventions. There was a significant interaction for professional group membership by intervention type on ratings of treatment acceptability. No significant effects of diagnostic label occurred. Implications of the present study and future research directions are discussed. © 1997 John Wiley & Sons, Inc.

Effects of professional group membership, intervention type, and diagnostic label on treatment acceptability

Differences in ratings of treatment acceptability among groups of individuals who are often involved in the recommendation, selection, implementation, and evaluation of behavioral interventions in educational settings were examined. Teachers, school psychologists, and school social workers were presented with a vignette of a 3rd grade student exhibiting a pattern of disruptive problem behavior. The vignette was held constant but diagnostic labels (LD, BD, ADD) and interventions (verbal praise and token economy program versus time out from reinforcement program and verbal praise) for the child in the vignette were varied. After examining the vignette, participants rated the acceptability of the interventions. There was a significant interaction for professional group membership by intervention type on ratings of treatment acceptability. No significant effects of diagnostic label occurred. Implications of the present study and future research directions are discussed. © 1997 John Wiley & Sons, Inc.

SOCIAL WORKERS’ ACCEPTABILITY RATINGS OF BEHAVIORAL TREATMENTS AND PHARMACOTHERAPY FOR THE MANAGEMENT OF GERIATRIC BEHAVIOR PROBLEMS

The purpose of the present study was to obtain treatment acceptability ratings from social workers whose client contacts include a high percentage of persons age 60 or older. Social workers were presented with written scenarios depicting a 75‐year‐old woman with a behavior problem. The client in the case varied by cognitive capacity (nondemented or experiencing dementia), living situation (living with a family caregiver or in a nursing home), and presenting problem (aggression, verbal abuse, or noncompliance). Using Kazdin's (1980) Treatment Evaluation Inventory, participants rated three treatments: positive reinforcement, time out from positive reinforcement, and haloperidol. Although ratings for time out varied by presenting problem, the highest acceptability for each type of behavior problem was assigned to the positive reinforcement condition, followed by time out, with the lowest ratings associated with haloperidol.

TREATMENT ACCEPTABILITY AND “FAKING GOOD”: ARE STAFF TELLING US WHAT THEY THINK WE WANT TO HEAR?

Treatment acceptability refers to how acceptable various treatment alternatives are to individuals who are subjected to and who implement those treatments. While treatment-acceptability research increases in popularity, some have questioned its usefulness. In particular, Schwartz and Baer (1991) question whether staff might be telling us what we want to hear, analogous to the phenomenon of test-takers “faking good” while taking personality tests. In this study, we sought to investigate the possibility of such bias in treatment-acceptability ratings. Direct-care staff at a large residential facility were presented with a clinical vignette and five treatment options to rate. They also received three different types of instructions (standard, “fake good,” and “prompted honesty”) designed to determine whether biases in ratings would appear. Results indicate that, under these conditions, staff do not fake good, i.e., there were no differences across instructional conditions. Collapsing across conditions, staff did differ in their ratings on the five treatment alternatives. Reasons for current results and suggestions for further research are discussed.

TREATMENT ACCEPTABILITY AND “FAKING GOOD”: ARE STAFF TELLING US WHAT THEY THINK WE WANT TO HEAR?

Treatment acceptability refers to how acceptable various treatment alternatives are to individuals who are subjected to and who implement those treatments. While treatment-acceptability research increases in popularity, some have questioned its usefulness. In particular, Schwartz and Baer (1991) question whether staff might be telling us what we want to hear, analogous to the phenomenon of test-takers “faking good” while taking personality tests. In this study, we sought to investigate the possibility of such bias in treatment-acceptability ratings. Direct-care staff at a large residential facility were presented with a clinical vignette and five treatment options to rate. They also received three different types of instructions (standard, “fake good,” and “prompted honesty”) designed to determine whether biases in ratings would appear. Results indicate that, under these conditions, staff do not fake good, i.e., there were no differences across instructional conditions. Collapsing across conditions, staff did differ in their ratings on the five treatment alternatives. Reasons for current results and suggestions for further research are discussed.

INCREASING TREATMENT ACCEPTABILITY THROUGH VIDEO

The effects of a video vignette on the treatment acceptability ratings of four behavioral interventions were evaluated. Two interventions involved positive reinforcement (DRO and DRI) and two negative consequences (contingent physical restraint and contingent electric shock). Seventy-four undergraduate psychology students were randomly assigned into two groups. The experimental group (n=36) viewed a video vignette of a self-abusive individual whereas the control group (n=38) did not. Acceptability ratings prior to the video showed no differences between the experimental and control groups. The post video ratings indicated significant acceptability increases for physical restraint for the experimental group. There also was a significant group by testing effect because the means for the experimental group rose whereas the control group's means were stable. These results replicated and extended Foxx, McHenry and Bremer (in press) who showed that treatment acceptability is alterable through video.

INCREASING TREATMENT ACCEPTABILITY THROUGH VIDEO

The effects of a video vignette on the treatment acceptability ratings of four behavioral interventions were evaluated. Two interventions involved positive reinforcement (DRO and DRI) and two negative consequences (contingent physical restraint and contingent electric shock). Seventy-four undergraduate psychology students were randomly assigned into two groups. The experimental group (n=36) viewed a video vignette of a self-abusive individual whereas the control group (n=38) did not. Acceptability ratings prior to the video showed no differences between the experimental and control groups. The post video ratings indicated significant acceptability increases for physical restraint for the experimental group. There also was a significant group by testing effect because the means for the experimental group rose whereas the control group's means were stable. These results replicated and extended Foxx, McHenry and Bremer (in press) who showed that treatment acceptability is alterable through video.

The Effects of Two Sequential-Request Strategies on Teachers' Acceptability and Use of a Classroom Intervention

This study examined the effects of two sequential-request strategies foot-in-the-door (FrrD) and door-in-the-face (DITF) on teachers' ratings of treatment acceptability and implementation of a classroom intervention. Sixty-one teachers were randomly assigned to 1 of 3 experimental conditions in which they complied with a small initial request, failed to comply with a large initial request, or received no initial request. Teachers then rated the acceptability of a classroom intervention that they were asked to implement for 1 hr on each of 2 consecutive school days. Results showed the mean acceptability ratings for the DITF condition to be significantly lower than the control condition, but neither differed significantly from the FITD condition. Fewer teachers in the DITF condition implemented the intervention than controls. The implications of these results for applying social influence strategies to school consultation are discussed.

An assessment protocol for selective mutism: Analogue assessment using parents as facilitators

The purpose of this study was to present an assessment protocol for conducting a functional analysis of maintaining variables for children with selective mutism. A parent interview was used to identify hypotheses related to mute behavior. The parent initially was trained in, and demonstrated efficiency in, applying various behavior strategies designed to increase speech. During a subsequent analogue assessment, the parent was directed to apply different strategies in both easy demand and hard demand situations. Direct observation of speech rates was analyzed to select the most promising treatments for an 8-year-old girl who spoke only with family members and was able to maintain speech in the presence of unfamiliar adults when stimulus fading techniques were used. Additionally, a contingency that required speech as a criterion for play in a family game was effective in increasing speech. Parent and child ratings of treatment acceptability were obtained for the analogue procedures as well as specific treatment strategies and revealed positive perceptions. A written summary of treatment recommendations was given to parents and to involved professionals. Implications for future assessment of selective mutism are presented.

Assessment and Intervention for the Problem Behaviors of an Adult at Home

Damon, a 37-year-old man with severe retardation (IQ = 39), lived at home with his mother and, for the past 15 years, had worked in a sheltered workshop. Incidents of problem behavior had been rare both at home and at work. Two weeks before this study started, Damon's behavior changed suddenly. When asked to get up in the morning to get ready for work, he yelled, “No” and threw things at his mother. If she persisted, his behavior escalated into hitting, kicking, and swearing. This study was conducted in two phases. The first phase, which combined descriptive and experimental (analogue) methods, indicated that Damon's problem behaviors were escape motivated, but did not indicate the specific activities or conditions from which Damon wanted to escape. The second phase included additional descriptive assessment with the workshop staff, and hypothesis development and hypothesis testing and intervention within naturally occurring routines at home. These procedures identified that Damon's problem behaviors did not occur when he was able to participate in a more preferred activity (a day activity program), whether or not he was allowed to choose the preferred activity. The resultant intervention immediately eliminated all problem behavior and received very high treatment acceptability ratings from Damon's mother, the person who was directly responsible for its implementation in the home.

Elders' Acceptability Ratings of Behavioral Treatments and Pharmacotherapy for the Management of Geriatric Behavioral Disturbances

The management of geriatric behavioral disturbances presents a challenge for both caregivers and care receivers. Previously, we have investigated caregivers' and health care professionals' perceptions of the acceptability of behavioral treatments and pharmacotherapy. However, the perceptions of the potential or actual recipients of these interventions are equally important. In this study, vignette methodology assessed elderly individuals' acceptance of two behavioral treatments and one pharmacologic intervention using Kazdin's Treatment Evaluation Inventory. Respondents assigned the highest treatment acceptability ratings to behavioral treatments and the lowest to drug therapy. The place of patient residence described in the vignettes (community or nursing home) mediated treatment acceptability ratings.

Functional Assessment and Intervention in a Regular Classroom Setting for the Disruptive Behavior of a Student with Attention Deficit Hyperactivity Disorder

Corey, an 8-year-old boy with Attention Deficit Hyperactivity Disorder (ADHD), attended regular third-grade classes at his local elementary school. During various academic instruction, Corey frequently displayed disruptive behaviors that rarely occurred during the rest of the school day. Assessment and intervention involved a three-phase study. The first phase, a brief functional (analog) analysis, identified that Corey's disruptive behaviors were maintained by escape from task demands. The second phase, a curriculum-based assessment, identified that Corey's disruptive behavior occurred most frequently during specific seating and grouping arrangements. The third phase examined the effectiveness of an intervention derived from the assessments. Results showed an immediate reduction in disruptive behavior and an increase in appropriate behavior that lasted throughout the data collection period. The intervention received very high treatment acceptability ratings from the teaching staff.

The impact of paradoxical interventions on perceptions of the therapist and ratings of treatment acceptability.

The impact of paradoxical interventions on perceptions of the therapist and ratings of treatment acceptability.