Evaluating the Treatment Fidelity of Parents Who Conduct In-Home Functional Communication Training with Coaching via Telehealth

Abstract

We conducted a retrospective, descriptive evaluation of the fidelity with which parents of three children with autism spectrum disorders conducted functional communication training (FCT) in their homes. All training was provided to the parents via telehealth by a behavior consultant in a tertiary-level hospital setting. FCT trials coached by the behavior consultant were conducted during weekly 1-h visits. Parents made video recordings of treatment trials in which they conducted the procedures independent of coaching. We evaluated the levels of fidelity during coached and independent trials within a multielement design and recorded parents’ omission and commission errors during different components of the treatment over time. The results showed no consistent differentiation between the coached and the independent trials. Some errors (e.g., omission errors associated with reinforcing manding) occurred more frequently overall, but none of the errors appeared to have a strong relationship with treatment outcomes. All children showed substantial reductions in problem behavior during the final treatment trials and especially during the coached trials. These results suggest that behavior analysts can use telehealth to implement FCT with acceptable fidelity and to achieve substantial reductions in children’s problem behavior.

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References

  1. Arkoosh, M. K., Derby, K. M., Wacker, D. P., Berg, W., McLaughlin, T. F., & Barretto, A. (2007). A descriptive evaluation of long-term treatment integrity. Behavior Modification, 31(6), 880–895.

    Article  PubMed  Google Scholar 

  2. Asmus, J. M., Ringdahl, J. E., Sellers, J. A., Call, N. A., Andelman, M. S., & Wacker, D. P. (2004). Use of short-term inpatient model to evaluate aberrant behavior: Outcome data summaries from 1996–2001. Journal of Applied Behavior Analysis, 37, 283–304. doi:10.1901/jaba.2004.37-283.

    Article  PubMed  Google Scholar 

  3. Barretto, A., Wacker, D. P., Harding, J., Lee, J., & Berg, W. K. (2006). Using telemedicine to conduct behavioral assessments. Journal of Applied Behavior Analysis, 39, 333–340. doi:10.1901/jaba.2006.173-04.

    Article  PubMed  Google Scholar 

  4. Carr, E. G., & Durand, V. M. (1985). Reducing behavior problems through functional communication training. Journal of Applied Behavior Analysis, 18, 111–126.

    Article  PubMed  Google Scholar 

  5. Carroll, R. A., Kodak, T., & Fisher, W. W. (2013). An evaluation of programmed treatment integrity errors during discrete-trial instruction. Journal of Applied Behavior Analysis, 46, 379–394.

    Article  PubMed  Google Scholar 

  6. DiGennaro, F. D., Martens, B. K., & Kleinmann, A. E. (2007). A comparison of performance feedback procedures on teachers’ treatment implementation integrity and students’ inappropriate behavior in special education classrooms. Journal of Applied Behavior Analysis, 40, 447–461. doi:10.1901/jaba.2007.40-447.

    Article  PubMed  Google Scholar 

  7. Durand, V. M., & Carr, E. G. (1985). Self-injurious behavior: Motivating conditions and guidelines for treatment. School Psychology Review, 14, 171–176.

    Google Scholar 

  8. Fryling, M. J., Wallace, M. D., & Yassine, J. N. (2012). Impact of treatment integrity on intervention effectiveness. Journal of Applied Behavior Analysis, 45, 449–453. doi:10.1901/jaba.2012.45-449.

    Article  PubMed  Google Scholar 

  9. Harding, J. W., Wacker, D. P., Berg, W. K., Lee, J. F., & Dolezal, D. (2009). Conducting functional communication training in home settings: A case study and recommendations for practitioners. Behavior Analysis in Practice, 2(1), 21–33.

    PubMed Central  PubMed  Google Scholar 

  10. Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1994). Toward a functional analysis of self-injury. Journal of Applied Behavior Analysis, 27, 197–209. (Reprinted from Analysis and Intervention in Developmental Disabilities, 2, 3–20, 1982). doi:10.1901/jaba.1994.27-197.

  11. Kurtz, P. F., Chin, M. D., Huete, J. M., Tarbox, R. S. F., O’Connor, J. T., Paclawskyj, T. R., et al. (2003). Functional analysis and treatment of self-injurious behavior in young children: A summary of 30 cases. Journal of Applied Behavior Analysis, 36, 205–219. doi:10.1901/jaba.2003.36-205.

    Article  PubMed  Google Scholar 

  12. Lindgren, S. D, & Wacker, D. P. (2011). Behavioral treatment through in-home telehealth for young children with autism [Grant R40MC22644]. Washington, DC: U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau.

  13. Mace, F. C., Lalli, J. S., Shea, M. C., Lalli, E. P., West, B. J., Roberts, M., et al. (1990). The momentum of human behavior in a natural setting. Journal of the Experiment Analysis of Behavior, 54, 163–172. doi:10.1901/jeab.1990.54-163.

    Article  Google Scholar 

  14. Mace, F. C., McComas, J. J., Mauro, B. C., Progar, P. R., Taylor, B., Ervin, R., et al. (2009). The persistence-strengthening effects of DRA: An illustration of bidirectional translational research. The Behavior Analyst, 32(2), 293–300.

    PubMed Central  PubMed  Google Scholar 

  15. Nevin, J. A., & Wacker, D. P. (2013). Response strength and persistence. In G. J. Madden (Ed.), APA handbook of behavior analysis, Vol. 2 (pp. 109–128). Washington, DC: APA Books. doi:10.1037/13938-005.

    Google Scholar 

  16. Pelios, L., Morren, J., Tesch, D., & Axelrod, S. (1999). The impact of function analysis methodology on treatment choice for self-injurious and aggressive behavior. Journal of Applied Behavior Analysis, 32, 185–195.

    Article  PubMed  Google Scholar 

  17. Reimers, T., & Wacker, D. (1988). Parents’ ratings of the acceptability of behavioral treatment recommendations made in an outpatient clinic: A preliminary analysis of the influence of treatment effectiveness. Behavioral Disorders, 14, 7–15.

    Google Scholar 

  18. St. Peter-Pipkin, C. S., Vollmer, T., & Sloman, K. N. (2010). Effects of treatment integrity failures during differential reinforcement of alternative behavior: A translational model. Journal of Applied Behavior Analysis, 43, 47–70.

  19. Tiger, J. H., Hanley, G. P., & Bruzek, J. (2008). Function communication training: A review and practical guide. Behavior Analysis in Practice, 1(1), 16–23.

    PubMed Central  PubMed  Google Scholar 

  20. Volkert, V. M., Lerman, D. C., Call, N. A., & Trosclair-Lasserre, N. (2009). An evaluation of resurgence during treatment with functional communication training. Journal of Applied Behavior Analysis, 42, 145–160.

    Article  PubMed  Google Scholar 

  21. Wacker, D. P., Berg, W. K., Harding, J. W., Barretto, A., Rankin, B., & Ganzer, J. (2005). Treatment effectiveness, stimulus generalization, and acceptability to parents of functional communication training. Educational Psychology, 25(2–3), 233–256. doi:10.1080/0144341042000301184.

    Article  Google Scholar 

  22. Wacker, D. P., Berg, W. K., Harding, J. W., Derby, K. M., Asmus, J. M., & Healy, A. (1998). Evaluation and long-term treatment of aberrant behavior displayed by young children with disabilities. Developmental and Behavioral Pediatrics, 19(4), 260–266. doi:10.1097/00004703-199808000-00004.

    Article  Google Scholar 

  23. Wacker, D. P., Harding, J. W., Berg, W. K., Lee, J. F., Schieltz, K. M., Padilla, Y., et al. (2011). An evaluation of persistence of treatment effects during long-term treatment of destructive behavior. Journal of the Experimental Analysis of Behavior, 96, 261–282. doi:10.1901/jeab.2011.96-261.

    Article  PubMed  Google Scholar 

  24. Wacker, D. P., Lee, J. F., Padilla Dalmau, Y. C., Kopelman, T. G., Lindgren, S. D., Kuhle, J., et al. (2013a). Conducting functional communication training via telehealth to reduce the problem behavior of young children with autism. Journal of Developmental and Physical Disabilities, 25, 35–48.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Wacker, D. P., Lee, J. F., Padilla Dalmau, Y. C., Kopelman, T. G., Lindgren, S. D., Kuhle, J., et al. (2013b). Conducting functional analyses of problem behavior via telehealth. Journal of Applied Behavior Analysis, 46, 1–16.

    Google Scholar 

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Acknowledgments

This investigation was supported by Grant R40MC22644 from the Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services. The content is solely the responsibility of the authors and does not necessarily represent the official views of the grant agency. The authors express their appreciation to Agnes DeRaad for her editorial assistance and to the families of the participants.

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Correspondence to Alyssa N. Suess.

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Suess, A.N., Romani, P.W., Wacker, D.P. et al. Evaluating the Treatment Fidelity of Parents Who Conduct In-Home Functional Communication Training with Coaching via Telehealth. J Behav Educ 23, 34–59 (2014). https://doi.org/10.1007/s10864-013-9183-3

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Keywords

  • Treatment fidelity
  • Functional communication training
  • Telehealth