Association for Behavior Analysis International

Behavioral techniques implemented by direct-care staff and caregivers are an essential component of effective intervention. Thus, it remains important that the quality of implementation by such individuals be evaluated. The studies in this symposium will discuss the outcomes of trainings to teach professionals and caregivers to implement behavioral techniques. Three of the four studies also examined the practicality of virtually delivered training. In the first study, Kanaman and colleagues assessed the efficacy of an intervention package informed by the Performance Diagnostic Checklist-Human Services (PDC-HS) to increase staff implementation of healthy behavior practices in a residential home for adults with intellectual and developmental disabilities (IDD). Next, Tsami and colleagues evaluated the outcomes of a caregiver-implemented intervention package aimed to increase cooperation to routine dental procedures by adults with IDD. In the third study, Walker and colleagues examined the feasibility of caregiver-led behavior intervention to increase Continuous Positive Airway Pressure (CPAP) machine use by adults with Down syndrome and sleep apnea. Finally, Fuller and colleagues evaluated the efficacy of training child welfare case managers to develop individualized behavior intervention programs addressing youth runaway behaviors derived from the results of the Functional Assessment Interview for Runaways (FAIR).

Some adults with intellectual and developmental disabilities (IDD) are uncooperative during routine dental exams, leading to problems with oral health. This presentation describes an interdisciplinary model consisting of behavior analysts and dentists aiming to evaluate and promote compliance to dental exams. The behavior analyst coached caregivers via telehealth to conduct mock exams with the participants in their homes and coached dentists to conduct exams with participants at a large hospital clinic. Caregivers of participants who exhibited noncompliance during the dentist-delivered exams then received behavioral services. The behavior analyst coached the caregivers via telehealth to implement increasingly complex interventions to increase the participants’ cooperation during mock dental exams. Nine of the fifteen participants were compliant in the absence of any interventions. Noncontingent reinforcement was effective for two participants. The remaining participants required graduated exposure. Additionally, compliance at home with the caregiver during the mock exam predicted compliance at the clinic during an exam with the dentist for all 15 participants.

A common sleep disorder among individuals with Down syndrome is obstructive sleep apnea (OSA). The most common treatment of OSA is Positive Airway Pressure (PAP) therapy. However, adherence to PAP therapy prescriptions is low. The high prevalence of OSA and low adherence with PAP therapy emphasized the need for an intervention to increase PAP machine use in individuals with DS. The following study evaluated a caregiver-implemented behavioral intervention aiming to increase PAP machine use in adults with DS using a multiple baseline across participants design. Participants in this study included four adults diagnosed with DS and OSA. The researchers utilized behavioral skills training via videoconferencing software to train the caregivers to implement the intervention. The intervention included the use of graduated exposure to the PAP therapy (i.e., slow progression of steps leading up to 4 hours of PAP machine use), differential negative reinforcement (i.e., longer breaks following compliance, shorter breaks following noncompliance with the graduated exposure step), contingent positive reinforcement (i.e., rewards following compliance with the graduated exposure step) and noncontingent reinforcement (i.e., access to a leisure item during intervention sessions). This caregiver-implemented behavioral intervention was effective at increasing PAP machine use for all participants. The results of this study serve as preliminary results for the effectiveness of this behavioral intervention when implemented by caregivers.