Story Intervention Research Articles

Social Story Intervention Through the Neurodiversity Lens

The neurodiversity movement is reshaping how we conceptualize neurodevelopmental differences—emphasizing the inherent value of diverse neurological experiences and advocating for meaningful societal inclusion. This article explores the neurodiversity paradigm and considers its implications for the evaluation of social stories intervention based upon metrics that agree with the neurodiversity movement instead of ableist “evidence” of behavioral improvement. Social stories are explained as a strategy aimed at supporting cognition for autistic individuals which respects the autistic experience. Specific guidance is provided for how social stories can be evaluated as a person-centered tool that respects and accommodates individual neurodiversity. Recommendations are made for ways in which to continue to improve and evaluate social story interventions.

Effects of Curriculum-linked Social Story Intervention with Video Self-modeling on Academic Engagement Behaviors of a High School Student with Autism Spectrum Disorders

Effects of Curriculum-linked Social Story Intervention with Video Self-modeling on Academic Engagement Behaviors of a High School Student with Autism Spectrum Disorders

Developing a Life Story Intervention for Older Adults With Dementia or at Risk of Delirium Who Were Hospitalized: Multistage, Stakeholder-Engaged Co-Design Study.

Older adults with chronic or acute cognitive impairment, such as dementia or delirium, who are hospitalized face unique barriers to person-centered care and a higher risk for negative outcomes stemming from hospitalizations. There is a need for co-designed interventions adapted for these patients to the hospital setting to improve care and outcomes. Patient life storytelling interventions have demonstrated promise in enhancing person-centered care by improving patient-care team relationships and providing information to enable care tailored to individual needs and values. This study aims to engage patients, care partners, and clinical stakeholders in a co-design process to adapt an existing life storytelling model for use with older adults with dementia and at risk of delirium in the acute care hospital setting. We recruited patients with dementia or at risk of delirium who were hospitalized, their care partners, clinicians, and informaticists. A 3-stage co-design process that used a mixed methods data collection approach including in-depth interviews and surveys was completed. We used content analysis to analyze qualitative data and descriptive statistics to summarize quantitative data. In total, 27 stakeholder informants (ie, patients, care partners, and interdisciplinary care team [IDT] members) participated. Stakeholders were unanimously interested in using patient life stories as a tool for hospital care through electronic health record (EHR) integration. Stakeholders shared potential topics for life stories to cover, including social support, information on patients' key life events, and favorite activities. Participants provided insights into the logistics of integrating life stories into acute care, including interview arrangement, story-sharing methods, and barriers and facilitators. IDT members shared preferences on EHR integration, resulting in 3 co-designed mock-ups of EHR integration options. Stakeholders shared ways to optimize future acceptability and uptake, including engaging with the care team and promoting awareness of life stories, ensuring suitability to the acute environment (eg, distilling information in an easily digestible way), and addressing concerns for patient capacity and privacy (eg, engaging care partners when appropriate). Thoughts on potential impacts of life stories were also elicited, including improving patient- and care partner-IDT member relationships; humanizing patients; increasing clinical team, patient, and caregiver satisfaction; and enabling more specific, tailored care for patients with dementia and at risk of delirium. This study resulted in a co-designed life storytelling intervention for patients with dementia and at risk for delirium in an acute care hospital setting. Stakeholders provided valuable information to ensure future intervention acceptability and uptake, including potential benefits, facilitators, and challenges in the acute care setting.

Social Story Intervention for Training Expected Behaviors among Preschool Children: A Systematic Review and Meta-Analysis.

Promoting appropriate behaviors in early childhood is crucial for children's future development. This systematic review aimed to explore the efficacy of social story (SS) intervention in teaching expected behaviors among preschool children. A structured search strategy was applied to five online electronic databases. The references were systematically screened in accordance with the PRISMA statements. Randomized or non-randomized controlled studies, as well as single-subject studies, in which SSs served as a behavioral training approach for children aged 2 to 6 years were included. Information related to study design, characteristics of the participants, target behaviors, and implementation of SS intervention was extracted. A meta-analysis was performed using the random-effects model, where similar outcomes were evaluated by similar intervention across multiple studies. Twenty-one studies were identified for qualitative analysis, while two studies formed the basis of the meta-analysis. SS interventions were employed to teach a variety of behaviors among typically developing children as well as those with various disabilities, such as autism, developmental delay, hearing impairments, attention deficit hyperactivity disorder, or other disabilities. The target behaviors included oral health practices, peer interaction, staying on-task, self-regulation, sleep habits, and controlling aggressive behavior during group activities. The SSs were used either alone or combined with other strategies, such as positive reinforcement, music therapy, role play, group discussion, video self-modeling, immediate practices, or additional audio commentary. Most studies reported improvements in appropriate behaviors and/or reductions in unfavorable behaviors. The meta-analysis indicated that children practiced more toothbrushing steps when using SS interventions compared to conventional oral health instruction (Z = 3.60, MD = 0.66, 95%CI 0.30 to 1.02, p < 0.001). SS interventions have the potential to teach target behaviors, particularly toothbrushing behaviors, among preschool children. More well-designed randomized controlled trials are warranted to determine the efficacy of SS interventions among children with various developmental profiles.

Recognizing the Need for Customized Social Stories: A Parent's Perspective in the Pakistani Context

This study explores the importance of customized social stories in the context of Pakistan to improve the social skills of children with Autism Spectrum Disorder (ASD). Data was collected from 62 parents of diagnosed children with ASD across various cities using a quantitative descriptive approach and survey method. The research instrument demonstrated a reliability score of Cronbach's Alpha 949, and field experts verified its validity. Findings reveal a solid parental desire to develop culturally relevant social stories to aid in teaching and supporting their children. Parents emphasized the effectiveness of these stories in enhancing their children's social skills and daily functioning. The use of social stories intervention for improving social skills among children with autism spectrum disorder is minimal, according to research that reviewed recent literature on the topic. It is because the social stories currently available are mainly in a western context, which does not accurately reflect Pakistan's social context, necessitating the development of customized social stories specifically tailored to the needs of Pakistan's current autistic population for different difficult social situations. This study will offer a piloted mechanism to assess the written and visual content of a given customized social story in the Pakistani context and a tentative framework for creating and assessing customized social stories to ensure their appropriateness for Pakistan's environment and culture. The study concludes that there is a significant need to create and disseminate customized social stories within the Pakistani context, providing valuable resources for parents to train better and support their children with ASD at home and in various social situations.

Single-Subject Study on the Effects of Social Stories on the Social Interaction of a Child with Autism Spectrum Disorder in China

ABSTRACT Intervention using social stories is a widely used strategy for children with autism spectrum disorder. However, empirical studies on the efficacy of social stories in improving social interaction have yielded mixed results, and such research in China is scarce. This study examined the effectiveness of social stories for increasing social interaction, particularly initiation and response, verbal exchange, body language, eye contact, and combined interaction of a child with autism spectrum disorder. A single-subject experimental study was conducted with two baseline sessions, two intervention phases, and a follow-up period. The results demonstrated immediate and maintained effects after utilising social story intervention. The participant’s response behaviours improved more than initiation, and body language as well as eye contact improved more than verbal and combined interaction. Social validity findings revealed positive evaluations of the participant’s mother and head teacher. Social story intervention is a promising strategy for improving the social interaction of children with autism spectrum disorder and that should be explored further in future research.

The power of digital story in early mathematics education: Innovative approaches for children with intellectual disabilities.

This study explored the effectiveness of digital story interventions in improving early math skills in kindergarten children with mild intellectual disabilities. Digital stories are multimedia narratives that combine text, images, and audio to enhance learning experience. This experimental study used a pretest-posttest control group design. The intervention group consisted of 15 children who participated in an 8-week digital story intervention targeting early math skills. A matched control group was used to control for sex differences. Data were collected through the TEMA-3 test scores and teacher and child feedback. Post-intervention, the experimental group showed significant improvements in TEMA-3 test scores compared to the control group. Teachers and children reported a positive perception of the intervention's social validity, highlighting enhanced engagement and understanding of math concepts. This study demonstrated that digital story-based education is a promising approach for improving early math skills in children with mild intellectual disabilities. These findings suggest potential implications for integrating digital storytelling into special education curricula and highlight avenues for future research in this field.

Building prosocial behaviours: Examining the possibilities of social stories in early childhood classroom settings

Prosocial behaviours such as sharing are essential for young children’s collaborative learning experiences and social development. When learnt during the early years, these behaviours enable positive peer interactions and relationship building in social settings, laying the foundation for young children’s social and emotional competencies with implications for individual and societal wellbeing. It is, therefore, critical that the early years are optimised to facilitate the development of young children’s prosocial behaviours. Set against this context, we present the findings of our qualitative teacher inquiry project that examined the role of social stories intervention in developing children’s prosocial behaviours, particularly sharing. The study was conducted at a private kindergarten in Singapore with four preschool children between the ages of four and five with difficulties in sharing resources with peers in classroom settings. The findings show children’s gradual progress from self-centred behaviours to independent problem-solving and other-oriented sharing behaviours, demonstrating the importance of consistency, teacher facilitation and authenticity as the three key elements of a successful social stories intervention. Thus, this small-scale qualitative study adds value to the limited literature on social stories intervention to promote sharing behaviours in preschool children.

Development and Evaluation of Digital Interactive Mendelian Genetics Comic Stories (DIMenGeComs) For Enhancing Conceptual Understanding of High School Students

The goal of this study is to amplify knowledge of Mendelian genetics, a difficult topic in Biology classes. The study used a multi-phase methodology, beginning with a needs assessment to identify teaching and learning challenges using structured surveys with teachers and students. The second phase integrated teacher and student feedback into developing a Digital Interactive Mendelian Comic Stories (DIMen Ge ComS) Intervention, utilizing a sequential explanatory mixed-methods research design following the ADDIE model. In the last stage, the intervention is implemented in a Grade 8 classroom, and the conceptual gain of the students is evaluated. Thematic analysis for qualitative insights, mean computation for rating scales, and normalized gain for quantitative assessment are examples of data analysis techniques used in the study. Moreover, ethically informed permission and participant anonymity were given top priority. The main objective is to develop and provide cutting-edge teaching tool that improves students’ comprehension of and interest in Mendelian genetics. The developed DIMenGeComS received an “Excellent” rating from the 7 Biology and Technology experts indicating that all areas of education and work are sufficiently covered by the DIMenGeComS, and the overall caliber of the material is excellent. Ergo, the current study suggested implementing the material and employing conceptual gains from a pre-and post-test before and after the utilization of the DIMenGeComS to assess students’ understanding of Mendelian genetics.

Supporting autistic communities through parent-led and child/young person-led digital social story interventions: an exploratory study.

Social Stories (SS) is a socially-valid intervention for autistic children and young people (CYP) which is used widely by professionals and parents. Research suggests that whilst parents are in an ideal position to deliver interventions for their autistic CYP, a lack of procedural integrity can result in a great deal of variability in parent-mediated intervention outcomes. This exploratory study investigated the extent to which SS can be effectively developed and delivered, through digital mediation, by parents with little to no researcher input (n = 17, sample 1) and the factors that impact effectiveness. Furthermore, the study also investigated the extent to which digitally-mediated SS can support autistic CYP to develop and deliver their own stories, thereby utilising the intervention as a means for self-support and self-management (n = 5, sample 2). The outcomes of the study indicate that digital mediation can effectively support parent-led SS intervention. Findings also indicate that receptive/expressive language skills of autistic CYP, their level of systemizing, as well as the practice of consulting with the autistic CYP whilst identifying goals and developing stories, are individual and procedural characteristics which positively influence the effectiveness of the parent-led intervention. The study also found that digitally-mediated SS can be utilised as a self-support tool by autistic CYP themselves. The results inform the developing literature on digital interventions and support tools that aim to engage with, and involve further, the autistic community in the setting and authoring of interventions and research.

The effectiveness of social stories in an intervention program in late adolescence with high functioning autism spectrum disorders: A case study report

People with high-functioning autism (HFA) demonstrated significant social skill deficits compared to those typically developing. Relatively limited data is still known about the challenges faced (friendship, social networks) by adolescents with HFA and so far with a delayed diagnosis. The case study aimed to investigate social stories’ effectiveness by using an intensive intervention approach on a late-adolescent female with autism. A 17-year-old girl with a recent diagnosis of HFA was selected as a case study from a private Speech and Language Therapy Center to involve in an immediate intervention program. A single-case research design was used to monitor changes after an intervention. Specifically, observation and training lasted four weeks, plus two weeks of maintenance. The intervention was done exclusively with social stories personalised to her needs. The targeted behaviours were to enhance social interaction skills, especially her ability to make friends and improve communication. There was a positive response from the young female in the intensive intervention program. Moreover, she displayed more positive peer interaction throughout the intervention program (6 weeks). She managed to participate and ask peers to companies in High school, to start a conversation, and to call them into her house in a positive way 44 times in 6 weeks. In addition, after every intervention week, we recorded an increase in her positive interactions with peers. The results demonstrate that social story use enhances HFA adolescents' social engagement. This study provides insights into the relationship between intensive social story intervention, social communication and social interaction behaviours between adolescents with a recent diagnosis of HFA and peers. Moreover, the findings support the effectiveness of social stories in encouraging social interaction of a late adolescent with HFA.

Development of an app‐based life story intervention: Lessons learned from including persons living with dementia in focus group research

AbstractBackgroundA small‐scale focus group study was conducted utilizing persons living with dementia (PLWD) to inform the development of an app‐based life story review intervention.MethodTwo (Time 1 and Time 2) 60‐minute virtual (Zoom) focus groups were conducted 9 months apart with persons living with dementia (n = 5) and facilitated by research staff. In Time 1, participants were sent in advance a series of LifeBio MemoryTM tablet‐app prototypes and asked to provide specific feedback on the following: 1) ease of use, 2) clarity of instructions, 3) feasibility to use the product, and 4) potential impact on person‐centered care practices. Time 2 presented the complete app to participants for similar feedback. To maximize successful participation, participants received one‐on‐one support by research staff prior to focus groups. Assistance was provided with using Zoom and navigating the tablet and LifeBio MemoryTM prototype and app. Dementia‐friendly materials were created for participants. Research staff conducted a thematic analysis of all transcripts. Time 1 findings were utilized to inform product development based on PLWD‐specific feedback; Time 2 findings were utilized for product refinement.ResultAlthough the PLWD sample was small, promising acceptability and feasibility findings were reported. All 5 PLWD participated in Time 1 and Time 2 focus groups. Themes from Time 1 (prototype) findings included: 1) Comfort using app‐based product technology, 2) Value of sharing their life story, 3) Training issues, 4) Implementation concerns, and 5) Concerns with how PLWD are perceived. PLWD feedback, was integrated in the development of the product. Analysis of Time 2 determined: 1) Some remaining training concerns, 2) High levels of satisfaction, and 3) Buy‐in that a product like LifeBio MemoryTM can impact person‐centered care. Themes, recommendations, and action steps were proposed and changes were made in content and functionality, in preparation for an upcoming feasibility study to test the LifeBio MemoryTM app with PLWDs living in residential care (n = 242).ConclusionBy building in supports, persons living with dementia are able to successfully participate as members of a research team, providing valuable feedback as stakeholders in product development research; further, virtual delivery of focus groups is also possible.

상황이야기 중재가 자폐성 장애 유아의 사회적 행동에 미치는 영향

This study was conducted to investigate the effect of social story intervention on the social behavior of children with autism. The subjects of this study were three children with autism spectrumdisorder, two boys aged five and one boy aged four, who were diagnosed with autism spectrum disorder. For the study design, multiple probe baseline design across subjets was used. The place of intervention was the treatment roomin the integrated day care center where the children attended, and the social story for each child was produced and mediated considering the ability and disability characteristics of the participating children. The entire study was conducted in three phases: baseline, intervention, and maintenance. As a result of the study, it was found that social behaviors, which were rarely seen at the baseline, were gradually changed and positively increased as the social story intervention was conducted, and the changes were maintained even after the intervention was terminated. These results suggest that social story intervention is an effective intervention that positively affects the social behavior of children with autism spectrum disorder who have difficulty in social behavior.

INVOLVING PERSONS LIVING WITH DEMENTIA AS KEY STAKEHOLDERS: RESEARCH “WITH” RATHER THAN RESEARCH “ON”

Abstract Involving persons living with dementia (PLWD) as members of the research team is an important step in establishing an environment of conducting research “with” as opposed to research “on”. Emerging research is also capturing PLWDs' lived experiences to inform product development. This presentation highlights the importance of conducting product development research with PLWD as key stakeholders and the valuable insight they provide to researchers and developers. Five community-dwelling PLWD with varying diagnoses (60% mild cognitive impairment; 20% Alzheimer’s Disease; 20% mixed dementia) and tMMSE scores ranging from 22-26 (Mean=25) participated in two rounds (9 months apart) of 60-minute-long virtual focus groups via Zoom to test multiple versions of LifeBio MemoryTM: an app-based product designed for PLWD which utilizes advanced technology to improve an existing life story intervention. In Time 1, PLWD provided feedback on prototypes of the app and associated training that was used to inform the final product. In Time 2, participants reviewed the final product. A thematic analysis was conducted at each time point to inform further development of the app. Findings determined the following themes: 1) life stories can help with providing better person-centered care, 2) potentially sensitive topics require more training, 3) simple and clear instructions are vital for success. Topics further discussed in this presentation will include PLWDs': 1) thoughts on the concept of LifeBio and its adaptation, 2) comfort with answering life story interview questions, 3) opinions on dementia-friendly materials, and 4) reactions to the use of app-based technology.

Healing the Whole Family: A Graphic Story Intervention for AAPI Mental Health

Healing the Whole Family (HTWF) is a graphic novel about Asian American and Pacific Islander (AAPI) intergenerational and mental health. HTWF is a project sponsored by Yale Compassionate Home, Action Together (CHATogether), a research group focused on AAPI mental health. HTWF describes one girl’s struggle with her mental health and her family who, in the beginning, do not acknowledge mental health or illness. The story follows her struggles to understand her family’s dynamics and how intergenerational trauma within her family plays a large role. HTWF aims to: 1) portray a relatable story for AAPI families about mental health and illness; 2) educate AAPI families on topics such as intergenerational trauma, attachment theory, the circle of security, and adverse childhood experiences (ACEs); 3) encourage future conversations about mental health within AAPI families. The audience for HTWF is purposefully multigenerational and includes AAPI teenagers, young adults, and caregivers.This paper will first introduce HTWF and provide a summary of the graphic novel. Following sections will include a discussion about the intersection of Graphic Medicine and mental health and illness, analysis of visual metaphors (with corresponding excerpts shown from the graphic novel), and clinical implications of arts-based interventions in child and adolescent mental health.

Traumatic disclosures in the life stories of older Vietnam era veterans.

Eliciting life stories is an important component of person-centered care that may aid in understanding how an individual's unique background and narrative impacts their health. Such life stories, especially when gathered from older military Veterans, may include traumatic events, raising the urgency that clinicians be prepared to provide care that is trauma-informed and ensure Veteran's experiences are acknowledged and treated effectively. We examined the prevalence and type of potentially traumatic and/or adverse life events spontaneously shared by 231 older Veterans participating in a life story intervention while receiving care within the U.S. Veterans Health Administration system. Veteran life stories were extracted from the electronic medical record and deductive qualitative content analysis was used to code potentially traumatic or adverse life experiences based on a codebook adapted from the Brief Trauma Questionnaire and Adverse Childhood Experience questionnaire. A majority (71.0%) of Veterans described at least one traumatic disclosure in their life story. Among narratives with a disclosure of any type, more than half (53.0%) included descriptions of combat trauma, 21.5% noted a history of life-threatening illness, and 9.5% reported having been in a serious accident. Fewer noted adverse childhood experiences (19.5%). Elicitation of life stories among older Veterans may advance person-centered care and life stories frequently include disclosure of potentially traumatic and/or adverse life events. These findings underscore the normative experience of traumatic events among older Veterans and highlight the importance of developing age-sensitive trauma-informed care competencies.

Measuring the Influence of Curricular Content and Personal Stories on Substance Use Stigma.

Understanding of the lived experience is an important educational strategy for improving attitudes toward stigmatized patient groups. This study evaluated the influence of a personal story intervention on nursing students' attitudes toward people who use opioids and measured attitudinal change from students' regular mental health and addictions curriculum. This study used a single-group longitudinal design. Stigma outcomes were measured using the Opening Minds Provider Attitudes Toward Opioid Use Scale. Mean scores were analyzed for four time periods: control, social contact intervention, curricular component, and 3-month follow-up. Qualitative feedback also was collected. Stigma scores improved significantly from pre- to postsocial contact intervention. No differences were observed for curricular content, control period, or follow-up. Qualitative findings suggest the personal story was associated with positive student-reported attitudes. Integrating personal story interventions with traditional curriculum elements is a promising educational approach for improving perceptions and behaviors of nursing students toward people who use drugs. [J Nurs Educ. 2022;61(5):264-267.].

Does social stories intervention improve social skills among children with ASD?: A Systematic Review of the Literature

The aim of this review was to provide up-to-date information about Social Store research, focusing on its effectiveness on social skills. Electronic databases were searched. These mainly included: ERIC, Google Scholar, WoS, and PubMed, and Scopus indexed journals. The author extracted the data needed. He made a data form with the following information to be extracted: authors' names, year of publication, type of children, number of participants, gender, age, country, study design, and findings. The participants were all children with ASD. They were of both sexes (men and women). All were of young age (&gt; 13 years old). They were from different countries, and hence from different cultures. Most research studies (four studies: 66.6%) used pre- post design. While two studies (33.3%) used multiple baseline design across subjects. Findings indicated the effectiveness of the social stories intervention employed in improving the target skills and behaviours.

The Focus Group Must Go On: Lessons Learned from Conducting Virtual Focus Groups

The Covid-19 pandemic has presented a multitude of challenges in conducting research with human subjects. In response, researchers have found creative ways to complete these studies using alternative methods that incorporate social distancing. Fortunately, numerous technologies exist today that allow individuals to connect with one another over short and long distances. The current study describes the development of LifeBio Memory: an app-based product that utilizes artificial intelligence and machine learning to improve an existing life story intervention designed for persons living with dementia (PWD). Seven focus groups (n=35), originally planned in-person, were successfully converted to a virtual setting. Groups were hosted using a Zoom platform, lasted 75-90 minutes (Mean = 85; SD = 5.3), and consisted of participants from 14 different states: One group of community-dwelling PWDs with early-stage dementia (n=5); two groups of current and former users of the original LifeBio program (n=12); and four groups of residential care staff and directors (n=18). Virtual focus group delivery was determined to be an acceptable and feasible alternative to traditional in-person formats. Topics discussed in this poster will include: 1) recruitment procedures, 2) screening protocols, 3) methods for sharing materials, 4) guidance for providing technology support, and 5) communication strategies to increase retention. Further discussion will focus on challenges faced when collecting data in a virtual setting, tips for successful facilitation, advantages to using virtual alternatives, and other lessons learned from the virtual field.

Using Life Story Techniques with Diverse Communities: Lessons Learned from a Focus Group Study

Providing high quality, cost-effective dementia care remains a major health challenge. Life story work, used in residential care settings, helps engage persons living with dementia (PWD) at a low cost with minimal staff burden. LifeBio, one such intervention, is designed to elicit life history data and care preference information through comprehensive life story interviews. LifeBio Memory, an adaptation of LifeBio, utilizes novel speech-to-text technology to process life story data more efficiently. Seven focus groups were conducted to evaluate the acceptability and feasibility of LifeBio Memory. Three types of focus groups were held (n=35) and audio recorded: 1) One group of early-stage PWDs (n=5); 2) Two groups of current and former users of original LifeBio (n = 12); and 3) Four groups of residential care staff and directors (n=18). Sessions were transcribed and thematic analyses were conducted. Findings indicated high levels of acceptability and feasibility of LifeBio Memory. Further, a secondary theme emerged signaling the need to prioritize the emotional safety of PWDs participating in life story work. This poster will discuss: 1) the life story interview process, 2) identifying PWDs who would most benefit from a life story program, 3) involving family and staff care partners to identify sensitive topics, 4) interview question design, selection and order, and 5) expanding life story work across diverse communities. Discussion will highlight the importance of protecting the emotional well-being of marginalized communities by identifying potential underlying traumas that could impact the safe delivery of otherwise effective life story interventions.