|Utilizing Qualitative Methods to Inform Behavior Analytic Research
|Monday, May 29, 2017
|4:00 PM–5:50 PM
|Convention Center Mile High Ballroom 2B
|Area: PRA/DDA; Domain: Translational
|Chair: Caitlin H. Delfs (Marcus Autism Center; Emory School of Medicine; Children's Healthcare of Atlanta)
|Discussant: Jennifer R. Zarcone (Kennedy Krieger Institute)
|CE Instructor: Caitlin H. Delfs, Ph.D.
Existing research illustrates how qualitative research methods could be utilized in other fields, including educational research and behavioral sciences (Jacobs, 1987) and the following studies incorporate these methods to inform, evaluate, and measure outcomes of behavior analytic interventions. The first study included focus group data collected from Spanish-speaking caregivers to help develop a behavioral parent training (BPT) program for families with limited English proficiency. The results of the focus groups, as well as the results of the implementation of the BPT program are reported. The second paper examined the use of focus groups and interviews with parents, teachers, and school administrators to evaluate a school-based, comprehensive model to address the needs of students with autism. Feedback and recommendations to improve feasibility and acceptability were included. The third study reviewed the use of a qualitative measure of caregiver buy-in during admission in an outpatient program to address problem behavior. The relationship between caregiver buy-in and successful completion of the program will be discussed. The final study examined the use of structured observations, clinical interviews, and indirect assessments, along with quantitative measures to assess interventions for problem behavior. Results suggest that positive outcomes extend beyond reducing problem behavior.
|Instruction Level: Intermediate
|Keyword(s): caregivers, focus groups, qualitative research
Utilizing Focus Groups to Inform Behavioral Parent Training for Caregivers With Limited English Proficiency
|Caitlin H. Delfs (Marcus Autism Center; Emory School of Medicine; Children's Healthcare of Atlanta), BHAVNA KANSAL (Marcus Autism Center), William Walton (Marcus Autism Center), Claire Lea (Marcus Autism Center)
Although autism spectrum disorder (ASD) has been found to occur across a variety of ethnic, racial, and socioeconomic groups (CDC, 2010), further research is needed to evaluate how language and cultural barriers impact the effectiveness of interventions and modifications to standard practice (Baker-Ericzn, Stahmer, & Burns, 2007). Similarly, existing literature suggests that behavioral parent training (BPT) programs are considered a promising clinical and preventive intervention (Jang et al., 2011; Serketich & Dumas, 1996), yet very few researchers have examined the impact of BPT within specific cultural groups (Martinez & Eddy, 2005). In the current study, focus groups were developed to assess the barriers associated with accessing treatment options within the Latino community, and evaluate the perceived efficacy of BPT for caregivers with limited English proficiency (LEP) and a child with ASD. Participants were asked about previous experiences, perceived barriers to treatment, and suggestions for behavioral clinicians. Focus group transcriptions were thematically coded and used to inform modifications to staff training, service delivery, and curriculum for an existing, communitybased BPT intervention. The impact of the modifications will be monitored through assessing parent skills for 12 LEP parent-child dyads and both caregiver and therapist satisfaction and acceptability of service delivery.
Integrating Stakeholder Feedback Into a Comprehensive, School-Wide Intervention Through Qualitative Research Methodology
|Krystal M. McFee (University of South Florida), SUZANNAH J. IADAROLA (University of Rochester), Sheri Grace (Appalachian State University), Sharon Hodges (University of South Florida), Rose Iovannone (University of South Florida; Florida Mental Health), Tristram Smith (University of Rochester Medical Center), Cynthia M. Anderson (May Institute)
Myriad behavior analytic strategies are considered evidence-based for children with autism spectrum disorder (ASD); however implementing comprehensive intervention packages in public schools has been difficult. Implementation barriers, such as fidelity and buy-in, are especially challenging but not fully explored in the literature. To address gaps in intervention development and implementation, we developed Students with Autism Accessing General Education (SAAGE), a comprehensive, modular intervention for use by educators for students with ASD. Modules allow educators to support core and associated features of ASD and rely heavily on behavior analytic principles. SAAGE is implemented by a school team and a coach, who helps the team assess student needs, identify goals and select relevant modules. We used qualitative research methodology to obtain feedback on the model, via 9 focus groups and 3 interviews conducted with 22 teachers, 13 administrators, and 11 parents across four sites. Data were analyzed by thematic analysis; we achieved triangulation through multiple informants and independent coding. Results indicate overall positive feedback for SAAGE, as well as recommendations for fine-tuning the model. This feedback is being integrated to inform the final version of SAAGE, to support its feasibility, acceptability, and perceived helpfulness by prospective implementers and recipients of the intervention.
An Analysis of Caregiver Buy in for a Parent Training Program Targeting Problem Behavior
|WILLIAM WALTON (Marcus Autism Center, Children's Healthcare of Atlanta), Mindy Christine Scheithauer (Marcus Autism Center; Emory School of Medicine; Children's Healthcare of Atlanta), Jamieson Ekstrom (Marcus Autism Center), Sarah J. Miller (Marcus Autism Center / Emory University School of Medicine), Joanna Lomas Mevers (Marcus Autism Center), Nathan Call (Marcus Autism Center)
Past research has examined the effects of treatment integrity on the effectiveness of interventions for challenging behavior (Sterling-Turner, Watson, & Moore, 2002; Van Den Hoofdakker et al. 2007). Acceptability is a precursor to treatment integrity (Witt & Elliott, 1985), and acceptability may be thought of in terms of how bought-in a caregiver is to the treatment procedures. However, there has been only limited research on how to best measure acceptability or buy-in. In addition, the studies that have been conducted have used self-report (usually from teachers) and have generally assessed only pre- or post-treatment as opposed to analyzing buy-in throughout. This study extends the past research by examining caregiver buy-in (assessed by a 6 item, likert-scale questionnaire completed by a therapist observing the caregiver). In the present study, we analyzed data from this measure completed by the therapist at the second and third appointment of a 10-week outpatient behavioral treatment program targeting problem behavior. The caregiver buy-in measure was related to successful completion of the program, demonstrating the importance of considering caregivers buy-in to treatment procedures. Other aspects of reliability and validity (e.g., test-retest reliability) are also discussed.
|Beyond Percent Reduction: Global Outcomes of Interventions for Problem Behavior
|JOANNA LOMAS MEVERS (Marcus Autism Center; Children's Healthcare of Atlanta; Emory School of Medicine), Sarah J. Miller (Marcus Autism Center / Emory University School of Medicine), Whitney Turbyfield (Marcus Autism Center), Nathan Call (Marcus Autism Center)
|Abstract: Individuals who engage in problem behavior are likely to experience a number of negative outcomes, which can impact both the individual engaging in the problem behavior as well as the caregivers/families of these individuals (Estes et al., 2013; Sikora et al., 2013). To date it has been well established that interventions employing applied behavior analysis techniques are effective at reducing the rates of problem behaviors in these individuals (Von Schulz, 2014). However, little research has examined the broader impact of these interventions. The current study examined the use of structured observations, clinical interviews, and indirect assessments to evaluate the global impact of interventions for problem behavior. These measures were selected to evaluate different aspects including adaptive behavior, social responsiveness, severity of problem behavior, and caregiver stress. These measures were used in addition to more traditional measures such as percent reduction. Results suggest that this preliminary effort at identifying the collateral benefits of behavioral treatments for problem behavior demonstrate that positive outcomes extend beyond reducing problem behavior. Future research may benefit from identifying further measures that capture the range of domains impacted as well as identifying optimal times to conduct such measures.