Performance improvement in behavioral health care: collateral effects of planned treatment integrity observations as an applied example of schedule-induced responding.

With rising interest in the role of treatment integrity on student outcomes, research has primarily focused on isolating the techniques and procedures necessary to improve staff's acquisition and maintenance of adequate levels of integrity. Despite increasing numbers of publications on this topic, there has been little discussion of the variables surrounding the collection of integrity data. Using an archived database of logged integrity observations at a residential school for children with brain injury, the authors sought to examine the degree to which integrity data collection conformed to best practices of behavioral assessment with respect to temporal sequencing. Moreover, due to the agency's goal of collecting integrity on each student per month, the authors sought to examine whether the sequencing of integrity observations scalloped similarly to responding on conjunctive fixed-interval-fixed-ratio schedules. Results indicated that a majority of the staff exhibited some form of scalloping in their collection of integrity data. This article discusses possible sources of stimulus control and the potential for reactivity on the part of the teachers being observed when integrity observations are conducted in scalloped patterns. The authors conclude with a discussion on possible procedures to support the distributed collection of integrity data in applied setting.

Using performance feedback to improve treatment integrity of classwide behavior plans: an investigation of observer reactivity.

The current study replicated the positive effects of performance feedback on treatment integrity and extended previous work by examining reactivity using a multiple baseline design with alternating treatments for observer-present and observer-absent conditions on teachers' implementation of a classwide behavior plan. No differences were found between conditions, and treatment integrity improved across all teachers, suggesting that performance feedback, rather than observer reactivity, was responsible for reported behavior changes.

Functional analysis and treatment of chronic hair pulling in a child with cri du chat syndrome: effects on co-occurring thumb sucking.

The relation between hair pulling and thumb sucking in a child with Cri du Chat syndrome was evaluated during the assessment and treatment of hair pulling. A functional analysis suggested that both behaviors were maintained by automatic reinforcement and possibly by attention. Treatment combining differential reinforcement (praise), response interruption, and access to toys decreased hair pulling. A corresponding decrease in thumb sucking was observed even though it was not directly treated. After an initial evaluation in a controlled setting, the treatment was extended to the participant's classroom setting. A 1-year follow up revealed that hair pulling, but not thumb sucking, remained at near-zero frequency. Clinical and research-to-practice implications are discussed.

Effects of behavior-contingent and fixed-time release contingencies on frequency and duration of therapeutic restraint.

Reducing therapeutic restraint is a desirable outcome for programs that serve individuals who exhibit challenging behaviors. This study investigated the effects of modifying the criterion for release from therapeutic restraint on frequency and duration. Release from restraint was changed from a behavior-contingent criterion (restraint terminated when a specified duration of calm behavior was demonstrated) to a fixed-time criterion (restraint terminated when a predetermined duration elapsed independent of behavior) with one child and two adolescents with acquired brain injury and difficult-to-manage behaviors. For all three students, the duration of time they were exposed to therapeutic restraint decreased with the fixed-time release criterion, whereas the frequency of restraint did not change. Practical implications of these results and future research opportunities are discussed.

Effects of immediate performance feedback on implementation of behavior support plans.

Research has focused on increasing the treatment integrity of school-based interventions by utilizing performance feedback. The purpose of this study was to extend this literature by increasing special education teachers' treatment integrity for implementing antecedent and consequence procedures in an ongoing behavior support plan. A multiple baseline across teacher-student dyads (for two classrooms) design was used to evaluate the effects of performance feedback on the percentage of antecedent and consequence components implemented correctly during 1-hr observation sessions. Performance feedback was provided every other week for 8 to 22 weeks after a stable or decreasing trend in the percentage of antecedent or consequence components implemented correctly. Results suggested that performance feedback increased the treatment integrity of antecedent components for 4 of 5 teachers and consequence components for all 5 teachers. These results were maintained following feedback for all teachers across antecedent and consequence components. Teachers rated performance feedback favorably with respect to the purpose, procedures, and outcome, as indicated by a social validity rating measure.

Antecedent analysis of therapeutic restraint in children and adolescents with acquired brain injury: a descriptive study of four cases.

Therapeutic restraint is sometimes required as a component of clinical intervention for persons who have serious behaviour disorders. However, there are few studies that describe empirically the conditions under which restraint is utilized. This project was a retrospective analysis of incident reports on the application of therapeutic restraint with four students (ages 10-16 years) who had acquired brain injury and attended a community-based programme of education and neurorehabilitation. Specifically, situations and interactions were examined that were in effect immediately prior to the implementation of restraint. This antecedent analysis identified several common influences, as well as effects that were unique to individual students. The role of antecedent events as "precipitants" to restraint and respective treatment implications are discussed.