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Pyramidal Training, Research and the Right to Effective Treatment

November 30, 2015 3:00 pm Published by

Staff members serving people with developmental disabilities are often required to implement several behavior analytic procedures with only limited training soon after being hired.  Often, organizations that employ direct care staff have few qualified staff trainers, high rates of absenteeism and frequent staff turnover (Seavey, 2004; (Zaharia & Baumeister, 1979).

Pyramidal training allows supervisors, consultants or other experienced behavior analysts to train just a few direct care workers in agency required skills and then train these direct care workers to implement training packages targeting the same skills with their newly hired co-workers (Jones, Fremouw and Carples, 1977; Page, Iwata and Reid, 1982).

Pyramidal training reduces the burden on clinical supervisors of having to train every newly hired staff member and eliminates the need to hire additional staff trainers and consultants. It also allows trainees to practice skills in the general teaching environment which aids in the maintenance and generalization of the acquired skills (Van den Pol, Reid & Fuqua, 1983).

Published studies on pyramidal training have shown that the training design is effective for disseminating a variety of target skills such as classroom management tactics, discrete trial teaching procedures, implementation of client treatment plans, provision of positive social interaction, mand training and preference assessment.

Jones, Fremouw and Carples (1977) used a 1.5 hour training session to train three elementary school teachers to use a classroom management skills package and then to conduct role-playing and give corrective feedback in order to train their peers. These three teachers then trained 12 other elementary school teachers to use the classroom management skills package and this decreased student problem behavior.

Page, Iwata and Reid (1982) used written instructions, verbal instructions, discussion, rehearsal, verbal feedback and graphic feedback to train three institutional supervisors to discriminate correct teaching behaviors on the part of direct care staff and to instruct, prompt, and praise the occurrence of those behaviors.  Improvements in 45 direct care staff members’ teaching behavior were a function of training and feedback provided to their supervisors.

Shore, Iwata , Vollmer, Lerman and Zarcone (1995) used instructions, rehearsal and feedback to train one supervisor to implement client treatment programs, train seven direct care staff members in program implementation, and monitor the programs. Staff implementation of client treatment procedures and client behavior improved as a result of supervisor training.

Schlosser, Walker and Sigafoos (2006) used a one day workshop consisting of presentation, modeling, coaching, rehearsal and feedback to train three direct care staff members to provide opportunities for communication to children with developmental disabilities who were non-vocal. These three staff members then trained five additional staff members in the procedures. Staff members increased the number of opportunities for communication provided to their students as a result of training and student prompted and unprompted communications increased.

Finn and Sturmey (2009) used Behavioral Skills Training (BST) to train four habilitation specialists to train four of their co-workers to provide positive vocal, gesture, manual sign and physical interactions to adults with psychiatric disorders and developmental disabilities in a day habilitation setting.  The frequency and proportion of positive interactions and improved between trainees and clients as a result of the peer-to-peer training.

In an unpublished dissertation, Nigro-Bruzzi (2010) also used BST to train three supervisors to use BST to train three teacher assistants to conduct mand training. Supervisor use of BST was efficient in training 3 teacher assistants to conduct mand training accurately. All teacher assistants generalized staff teaching skills across children and the children showed increases in their percentages of unprompted mands.

The above studies made important contributions to the staff training research because they demonstrated the efficiency of the pyramidal training model to disseminate a variety of behavior analytic skills. However, the above studies also all presented with an important limitation.

None of the above studies that included learner participants throughout baseline and training detailed the ways in which they minimized harm to participating individuals with developmental and intellectual disabilities during baseline data collection. Baseline data collection refers here to those data collected on trainee performance before training. This type of data collection would require an untrained staff member to attempt to implement an evidence-based procedure with an individual with a disability.

Van Houten et al. (1988) detailed the importance of ensuring that all recipients or potential recipients of treatment designed to change behavior have a right to the most effective treatment procedures available. When research is conducted in the applied setting with individuals reliant on the hosting school, habilitation center or agency for their daily programming needs, the responsibility to ensure that learners access the above therapeutic rights falls upon the hosting school, habilitation center or agency and the experimenters. In other words, the burden of meeting baseline logic requirements should not be shouldered by recipients of behavior change programs, but by their providers and the researchers themselves. This distinction is especially important when it comes to research in the area of staff and caregiver training.

In behavioral research outside of the staff and caregiver training area, experimenters are often testing a behavior change procedure that is not yet evidence based. In these instances, it could first be argued that withholding of a particular therapy during baseline data collection is of little consequence, because the learner would not be exposed to the experimental procedure during regular therapy anyway. Second, recipients and their families complete lengthy informed consent processes when they will be involved in a study to test an experimental behavior change procedure. Third, learner participants may incur a benefit if they are exposed to an experimental treatment that is beneficial during the course of research participation, because they would not have been exposed to the procedure outside of the context of the research.

The three points above do not necessarily apply when it comes to staff training research. Staff training research most often targets the training of staff members and caregivers in already established, evidence based behavior change procedures. Therefore, when researchers expose learners to untrained staff members during baseline data collection procedures, they are withholding effective treatment from the learners in the interest of the research project, because the learners would access the effective provision of these services outside of the research context. Even in cases where parental consent or assent have been attained, this situation does not seem ideal in light of Van Houten (1988). In particular, when researchers evaluate the extent to which a pyramidal training program is effective for training staff in evidence based behavior change procedures, it behooves the researcher to explore ways of doing so that are least harmful to the learners with whom the targeted staff members work. This is even more important when the learners in question have been assigned to a particular therapeutic setting because they engage in behavior that is potentially dangerous to themselves and others and does not allow them to participate in less restrictive settings. In these situations, exposing learners to untrained staff members for the sake of baseline data collection not only results in the withholding of effective treatment from the learner, but also increases the risk of dangerous situations arising for both untrained staff members and learners when untrained staff members inevitably make instructional errors during baseline.

In closing, it is important for both school representatives and parents to discuss the risks of students being exposed to untrained staff members thoroughly with any researchers seeking to evaluate staff training packages at their program. Researchers, in turn, have a responsibility minimize these risks to the greatest extent possible by planning evaluations that do not involve exposing learners to untrained staff.

 

 

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Lindsay Maffei-Almodovar, MS Ed, MA, BCBA, has worked in the field special education since 2001. She joined Quality Services for the Autism Community (QSAC) in 2011 and is currently the ABA Training & Development Coordinator. She is responsible for designing, evaluating and monitoring staff training initiatives at both the preschool and Day School programs. Lindsay is a certified New York State Early Childhood General & Special Education Teacher and a Licensed Behavior Analyst. Lindsay is also a doctoral student in the Behavior Analysis Training Area of the Psychology Department at Queens College and The Graduate Center City University of New York (CUNY). Her research focuses on efficient methods of training staff members in evidence based behavior analytic procedures.

 

 

References:

Baumeister, A. A., & Zaharia, E. S. (1987). Withdrawal and commitment of basic-care staff in residential programs. In S. Landesman, P. M. Vietze, M. J. Begab, S. Landesman, P. M. Vietze, M. J. Begab (Eds.) , Living environments and mental retardation (pp. 229-267). Washington, DC, US: American Association on Mental Retardation.

Finn, L. L., & Sturmey, P. (2009). The effect of peer-to-peer training on staff interactions with adults with dual diagnoses. Research In Developmental Disabilities, 30(1), 96-106. doi:10.1016/j.ridd.2007.11.004

Jones, F. H., Fremouw, W., & Carples, S. (1977). Pyramid training of elementary school teachers to use a classroom management ‘‘skill package’’. Journal of Applied Behavior Analysis,10, 239–253.

Nigro-Bruzzi, D. (2011). The effects of pyramidal training on staff behavior and manding in children with autism. Dissertation Abstracts International, 71, 5107. Page, T. J., Iwata, B. A., & Reid, D. H. (1982). Pyramidal training: A large-scale application with institutional staff. Journal Of Applied Behavior Analysis, 15(3), 335-351. doi:10.1901/jaba.1982.15-335

Schlosser, R. W., Walker, E., & Sigafoos, J. (2006). Increasing Opportunities for Requesting in Children with Developmental Disabilities Residing in Group Homes through Pyramidal Training. Education And Training In Developmental Disabilities, 41(3), 244-252. Seavey, D. (2004). The cost of frontline turnover in long-term care. Better Jobs Better Care, IFAS/AAHSA.

Shore, B. A., Iwata, B. A., Vollmer, T. R., Lerman, D. C., & Zarcone, J. R. (1995). Pyramidal staff training in the extension of treatment for severe behavior disorders. Journal Of Applied Behavior Analysis, 28(3), 323-332. doi:10.1901/jaba.1995.28-323

Van den Pol, R. A., Reid, D. H., & Fuqua, R. W. (1983). Peer training of safety-related skills to institutional staff: Benefits for trainers and trainees. Journal of Applied Behavior Analysis, 16, 139–156.

Van Houten, R., Axelrod, S., Bailey, J. S., Favell, J. E., Foxx, R. M., Iwata, B. A., & Lovaas, O. (1988). The right to effective behavioral treatment. Journal Of Applied Behavior Analysis, 21(4), 381-384. doi:10.1901/jaba.1988.21-381

 

 

 

The Right to Effective Behavioral Treatment, Part 5

November 23, 2015 3:00 pm Published by

As mentioned in a previous post, my colleagues and I at the QSAC Day School are reviewing the tenets outlined by Van Houten et al. (1988) and how they may be interpreted or are currently being implemented within our school. Today I am reviewing the fifth tenet outlined by the authors, which states that “an individual has a right to behavioral assessment and ongoing evaluation” (p. 383). The variables that are investigated in a behavior analytic assessment are the fundamental principles of the field. Specifically, Behavior Analysts primarily look at the three-term contingency, or the ABC’s, which stands for antecedent, behavior, and consequence when analyzing a behavior. It is through an assessment of these variables that a treatment plan may be developed.

Van Houten et al. (1988) describe three stages necessary to complete a behavioral assessment, with the first being an interview. An interview is conducted with a variety of people who know the individual well. This allows the Behavior Analyst to look for similarities between interviewee responses and begin developing some potential hypotheses around the function of the behavior. Additionally, the interview may guide the following stages of assessment if it is learned that the behavior always or never occurs in some situations (e.g., time of day, setting, etc.). To help provide structure to the interview, there a number of “indirect” assessment tools that may be used. Some of the more commonly used assessment tools include the Motivation Assessment Scale developed by Duran & Crimmins (1988), the Functional Analysis Screening Tool or the “FAST” created by Iwata et al. (2013), and the Questions About Behavioral Function by Matson & Vollmer (1995).

Once the interviews have been completed, the second stage of analysis involves direct observation (and data collection) of the target behavior. With the information gathered from the interview in mind, the Behavior Analyst will observe the individual and, ideally, confirm the hypotheses created through the interview process. The length of direct observation may vary with each individual and with each target behavior. The Behavior Analyst needs to observe the target behavior enough times so that he/she can analyze the data that are collected and come to a clear conclusion of the function of the behavior.

The third and final step of analysis as outlined by Van Houten et al. (1988) is the development of a treatment plan. The protocols implemented in the treatment plan will vary considerably with the function of the specific behavior. In most cases, a treatment plan should involve noncontingent reinforcement to help eliminate the target behavior before it begins, extinction for the target behavior so that it does not continue to be reinforced, and differential reinforcement for an appropriate alternative behavior that will take the place of the target behavior. Data should continue to be collected on the occurrence of the target behavior even after the treatment plan has been developed to evaluate the plan’s effectiveness, identify any “unanticipated problems, and, if necessary, to modify the treatment plan” (p. 383).

Within the QSAC Day School we follow each of the stages of analysis described by Van Houten et al. (1988). Interviews may be conducted with the classroom teachers, teacher assistants, family members, and any other individuals who may be familiar with the student. The Teacher assists with the direct observation and data are collected on the target behavior throughout the entire school day. When enough data have been collected, the behavior plan is developed and reviewed by a Board Certified Behavior Analyst (BCBA). After the plan is implemented, data continue to be collected on the occurrence of the target behavior and are analyzed by a BCBA on at least a weekly basis.

 

 

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Todd A. Merritt, M.A., BCBA is currently a Senior Applied Behavior Analysis Coordinator at QSAC’s Day School. He received his bachelor’s degree in psychology from Western Michigan University, master’s degree in applied behavioral science from The University of Kansas, and is a Board Certified Behavior Analyst.

 

 

Durand, V. M., & Crimmins, D. B. (1988). Identifying the variables maintaining self-injurious behavior. Journal of Autism and Developmental Disorders, 18, 99-117.

Iwata, B. A., DeLeon, I. G., & Roscoe, E. M. (2013). Reliability and validity of the functional analysis screening tool. Journal of Applied Behavior Analysis, 46, 271-284.

Matson, J. L., & Vollmer, T. (1995). Questions about behavioral function (QABF). Baton Rouge, LA: Disability Consultants, LLC.

Van Houten, R., Axelrod, S., Bailey, J. S., Favell, J. E., Foxx, R. M., Iwata, B. A., & Lovaas, O. I. (1988). The Right to Effective Behavioral Treatment. Journal of Applied Behavior Analysis, 21(4), 381-384.

Strategies to Help Get Through the Holiday Season

November 16, 2015 3:00 pm Published by

The 2015 holiday season is officially here! And we begin our preparations to spend time with loved ones and partake in holiday events. The holiday season can be a stressful time of the year for everyone, but it can be especially challenging for an individual with an autism spectrum disorder. A little advanced planning and the following proactive strategies can help to decrease a loved ones’ anxiety and enhance their holiday experience with the whole family.

  • Keep the individual’s behavioral and sensory profile in mind when planning holiday events. For example, how will they respond to specific traditions? How long can they tolerate being seated at the table? Will they be able to tolerate noise levels? Do they have any sensitivities to specific foods, sounds, people, pets, etc.?
  • Prepare for the environment where the event will take place. If the event is outside of your home, consider designating a specific area for them to use in case they need some time away to decompress. Holiday events can be overwhelming and there may be too much sensory stimulation for the individual.
  • Prepare family members, especially children, of the individual’s needs and what they can do to help. Teach them some easy communication strategies. Communication is key!
  • Prior to any holiday event, set aside some time to practice sitting at the table as it would be the day of the gathering. This can include adjusting the lighting of the room, playing music, etc. If the individual uses a schedule, begin to incorporate a picture or text of the holiday event into their schedule during practice time. Make sure to provide reinforcement during and right after practice time.
  • Expose the individual to holiday food before the family gathering, in order to see what they do and do not like. This allows the individual to become more comfortable with the food offered the day of the event. Provide reinforcement if they try any new foods (e.g., a piece of their favorite food for trying a new food). Be prepared to bring or make foods which the individual enjoys so they can still participate at the table with the rest of the family in the event that their food repertoire is limited.
  • Set aside some activities that the individual likes if you know they will find the holiday event unpleasant, and/or if they have a short attention span. If the individual cannot tolerate loud noises, consider allowing them to wear headphones or build in breaks away from everything throughout the event.
  • When decorating your home for the holidays, consider doing so in gradual steps. Individuals with autism often thrive in predictable environments, and may not transition well when there are sudden changes in their routine and/or environment. Changing your home’s appearance in one day may be overwhelming to some. Give the individual an opportunity to help by allowing them to manipulate the decorations (as long as it is safe to do so) and help put them up. You can also give them an activity, such as stringing popcorn, together to hang on the tree.
  • Think about the individual’s sensitivity to lights if they have one. You can take them to a holiday themed store prior to decorating your home and observe their reactions. If the lights seem unpleasant, think about alternative decorations.
  • If the individual is at risk for putting things in their mouth (e.g., pine needles) or breaking ornaments, consider alternatives such as an artificial tree, placing the tree out of reach, plastic ornaments, etc.
  • Keep in mind the individual’s fine motor skills and practice opening presents if necessary. Use pictures on the gifts instead of name tags to recognize who the gift givers are.
  • If the individual comprehends the use of a calendar, use this as a tool to countdown the days until the event. This will offer greater predictability in preparation for the event.
  • Make sure to reinforce appropriate behaviors throughout the event!
  • If the individual uses an augmentative form of communication (e.g., iPad or PECS book), make sure they have it with them at all times. Communication is very important! Also, reinforce spontaneous attempts to communicate.
  • Schedule an early dinner or eat before the event if this will assist the individual.
  • Assign activities and tasks that the individual can handle so they can participate in some way (e.g., setting the table, cleaning up, playing with other children if age appropriate).
  • Keep an eye on precursor behaviors that may lead the individual to engage in maladaptive behaviors and intervene accordingly. For example, ask them if they need a break or take them for a walk.

Most importantly have fun and enjoy the holidays!!!!!!!

 

 

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Rocio Chavez, MA., MSEd., LBA is currently the Assistant Director for the Quality Services for the Autism Community’s (QSAC) After School Programs. She also facilitates a social skills group for children with high functioning autism and a sibling support group. Rocio holds a Master’s degree in Clinical Behavioral Applications from Queens College, and a dual master’s degree in General and Special Education, Birth-Grade 2 from Touro College. Rocio is also a licensed behavior analyst. She has provided clinical consultations in school and home based settings, and most recently provided consultation for the Broadway play The Curious Incident of The Dog in the Nighttime. Rocio has also assisted in designing staff training and student curriculum and has co-authored a chapter in the book Behavioral Detectives: A Staff Training Exercise Book in Applied Behavior Analysis. She has presented on various topics including stimulus-stimulus pairing and reinforcer assessments at The New York State Association for Behavior Analysis (NYSABA) convention as well as The Association for Behavior Analysis International (ABAI) convention. Rocio has conducted research on self-management training in preschoolers with autism and stimulus-stimulus pairing. She has worked with children and young adults on the autism spectrum for over ten years.

The Right to Effective Behavioral Treatment, Part 4

November 2, 2015 3:00 pm Published by

My colleagues and I at the QSAC Day School have been discussing the tenents outlined in the Van Houten et al. (1988) article over a series of blog entries. For this entry, I will be covering the fourth tenent outlined by Van Houten et al. which states that “an individual has a right to programs that teach functional skills” (p. 383).

As stated by Van Houten et al., “the ultimate goal of all services is to increase the ability of individuals to function effectively in both their immediate environment and the larger society” (p. 383). What this means for us at the QSAC Day School is that when developing a student’s curriculum, there are several factors at which we look. First, we look at assessment results. Decisions regarding what skills will be taught to a student will be made based on assessments of what the student can currently do and what areas/skills could be improved. Students’ programs are directly derived from areas/skills found to be deficient via completion of said assessments. Second, we look at the student’s IEP to ensure all goals outlined in the IEP are being targeted. We also look at the student’s age- what is appropriate for a 6 year old student to be working on may not be appropriate for a 15 year old student.

Once a skill has been selected, we then look at how the skill will be taught. It is important for us to look at not only what instruction we provide but also how we provide the instruction. When deciding on a skill to teach a student, we always think of what the long term purpose of teaching that skill is. This includes thinking about how the skill will transfer to the natural environment, how the skill will generalize to the home/community environment, how the skill will enhance the student’s community membership, and how this skill will have overall long lasting benefits for the student.

As stated by Van Houten et al., “unless evidence clearly exists to the contrary, an individual is assumed capable of full participation in all aspects of community life and to have a right to such participation” (p. 383). For us at the QSAC Day School, the focus of instruction is always to foster students’ independence and ultimately contribute to their participation in the community.

 

 

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Cynthia Martinez, M.S., M.S. Ed., ABA Coordinator, QSAC Day School has been with QSAC since 2007.  She started out as a Medicaid Service Coordinator, then transferred to the Day School where she was a classroom teacher for 4 and a half years.  Cynthia has been at her current position as an ABA Coordinator since 2013.  Cynthia has a Master’s degree in Special Education from The City College of New York and a Master’s degree in School Building Leadership from Touro College.

 

Van Houten, R., Axelrod, S., Bailey, J. S., Favell, J. E., Foxx, R. M., Iwata, B. A., & Lovaas, O. I. (1988). The Right to Effective Behavioral Treatment. Journal of Applied Behavior Analysis, 21(4), 381-384.

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QSAC is a New York City and Long Island based nonprofit that supports children and adults with autism, together with their families, in achieving greater independence, realizing their future potential, and contributing to their communities in a meaningful way by offering person-centered services.

QSAC pursues this mission through direct services that provide a supportive and individualized setting for children and adults with autism to improve their communication, socialization, academic, and functional skills.