| Evaluations of Telehealth-Delivered, Culturally Adapted, and Caregiver-Implemented Functional Analysis and Functional Communication Training Around the World
|Sunday, May 30, 2021
|6:00 PM–6:50 PM
|Area: AUT/DDA; Domain: Applied Research
|Chair: Yaniz C. Padilla Dalmau (Seattle Children's Hospital)
|CE Instructor: Yaniz C. Padilla Dalmau, Ph.D.
With the emergence of the COVID-19 pandemic, most behavior analysts have become more familiar with utilizing telehealth technology to deliver services to their local clients. The research teams presenting in today’s symposium have been leveraging telehealth service delivery models long before the pandemic to evaluate and deliver culturally-adapted services across areas in the world that have lower access to trained behavior analysts. The first presentation will describe a two-part study conducted in Africa via telehealth which includes a needs assessment of caregivers of children with Autism Spectrum Disorders (ASD), didactic instruction for caregivers, and individualized parent training in functional analysis (FA) and functional communication training (FCT). The second presentation will describe caregiver training of FA and FCT delivered via telehealth to families in South Asia with a focus on procedural integrity and generalization. The third presentation will illustrate an evaluation of culturally-adapted versus standard caregiver training during telehealth delivered FA and FCT for six families in India. All presentations will highlight effectiveness of interventions, social acceptability, in addition to cultural considerations in the delivery of telehealth caregiver-delivered FA and FCT across cultures.
|Instruction Level: Basic
|Keyword(s): caregiver training, FCT, functional analysis, telehealth
Practitioners and researchers interested in implementing and evaluating behavioral assessment and intervention via telehealth specifically to diverse populations across the world.
|Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) Describe methodologies for implementing caregiver-implemented functional analysis (FA) and functional communication training (FCT) through telehealth and some of the supporting research evidence; (2) Describe the cultural considerations and modifications made by the authors when delivering caregiver-conducted FA and FCT across cultures; (3) Describe changes the participant can make to their own practice to deliver FA and FCT via telehealth effectively across cultures.
| A Telehealth Model for Delivering Behavior Analytic Services to Families in Africa
|LOUKIA TSAMI (University of Houston, Clear Lake), Bertilde U Kamana (The May Institute ), Margaret Uwayo (Michigan State University; By Your Side Autism Services), Dorothea C. Lerman (University of Houston-Clear Lake)
|Abstract: Just 30 Board Certified Behavior Analysts (BCBAs) reside in Africa even though the continent’s population is four times larger than that of the United States (BACB Certificant Registry, n.d.). In this two-part study, caregivers of children with autism from 24 African countries completed an online needs assessment. Survey results indicated that (a) children with autism do not have access to free public education, (b) misconceptions about autism are common in many communities, and (c) parents have few opportunities to receive training on how to treat problem behavior. Following the survey, BCBAs located in the United States provided educational presentations for caregivers and professionals in various African countries and selected three families of children to receive individualized parent training services. The BCBA coached the caregivers via telehealth to conduct functional analyses and functional communication training with their children, who engaged in high levels of problem behavior at home. The intervention was effective for all children, and the caregivers reported satisfaction with the procedures and training modality. These findings replicate those of prior research indicating that this telehealth model is effective for providing behavior analytic services to families in underserved countries (e.g., Tsami et al., 2019).
| Training Caregivers in South Asia via Telehealth to Implement Function-Based Treatments for Problem Behavior
|NAOMI ALPHONSO (University of Houston, Clear Lake), Loukia Tsami (University of Houston, Clear Lake), Dorothea C. Lerman (University of Houston-Clear Lake), Marissa Matteucci (University of Houston, Clear Lake)
|Abstract: Recent research has indicated that training caregivers to conduct functional analyses (FA) and functional communication training (FCT) via remote coaching is a highly efficient and socially valid procedure (Wacker et al., 2013, Tsami, Lerman, & Toper-Korkmaz, 2019). In the evaluation of the telehealth approach, one area that has not been examined is the amount of prompting caregivers need to implement FCT sessions with high fidelity and the generalization of their skills to areas outside of trained situations. With three participants from South Asia, the current study evaluated caregivers’ procedural integrity in the absence of the primary therapist and in various settings with novel preferred items as a measure of generalization. Caregivers from two countries implemented the FCT protocols with high integrity which was successful in reducing problem behaviors for three of the four children diagnosed with autism. High rates of procedural fidelity were maintained in the absence of the primary therapist and with the caregivers using novel stimuli in different locations. All caregivers rated the procedures as acceptable and were satisfied with the results. These findings indicate that after receiving remote coaching, caregivers can independently generalize the behavioral procedures to various locations with sustained high integrity.
| One Size Fits One: Cultural Adaptations in the Remote Training of Care Providers
|Rima Hamawe (Family Model Behavior Therapy, LLC), Amanda Rose Garcia (Family Model Behavior Therapy, LLC), Maithri Sivaraman (Ghent University), TARA FAHMIE (California State University, Northridge)
|Abstract: Autism intervention is in its infancy with regards to considering cultural factors while describing best practices for recruitment, assessment, and treatment of individuals with autism. The drastic changes that have occurred world-wide in response to COVID-19 have led to an increased demand for evidence-based telehealth programming. Accompanying this is the demand for remote training, particularly in areas such as India where few certified behavior analysts exist. The purpose of this study was to closely examine the role that culture plays in remote parent coaching. We used either standard or culturally-adapted telehealth technologies to train six caregivers in India to implement functional analyses and functional communication training with their children with ASD. We evaluated culturally adapted training vs. standard caregiver training on acquisition of new skills, reductions in problem behavior, and social validity in our participants. We also compared the efficacy of our treatment using number of sessions to meet criterion, and number of session cancellations, and a direct measure of preference. Results showed no difference in the effectiveness and efficacy of both treatments but caregivers demonstrated higher preference for culturally-adapted treatment. These outcomes will be discussed in their relation to cultural competency and the proliferation of telehealth technologies worldwide.