As we read and talk about generalization, identify 2 specific concepts from this week’s readings and video that you can use in your current position. Share with your classmates what your c

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Journal of Behavioral Education (2018) 27:435–460 https://doi.org/10.1007/s10864-018-9304-0

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ORIGINAL PAPER

Exploring Issues of Generalization and Maintenance in Training Instructional Aides in a Public School Setting

Solandy Forte1,2 · Michael F. Dorsey1 · Mary Jane Weiss1 · Mark J. Palmieri2 · Michael D. Powers2

Published online: 3 July 2018 © Springer Science+Business Media, LLC, part of Springer Nature 2018

Abstract In today’s climate, with the ever-increasing demand for competent behavior ana- lytic services, it is necessary for behavior analysts to work across a variety of set- tings, including home, school, and community, overseeing instructional aide staf as the frontline providers of applied behavior analysis (ABA) services. It is com- mon practice for ABA practitioners to provide the supervision and training to par- ents, caregivers, and direct-care staf, who may have limited knowledge and experi- ence within the feld of ABA. In 2013, the Behavior Analysis Certifcation Board (BACB®) initiated an efort to establish standards for the training of instructional aides and direct-care staf in the delivery of instructional and treatment services based on the principles of ABA. This new standard and credential is known as a Registered Behavior Technician™ (RBT®). The purpose of this study was to evalu- ate the training process outlined by the BACB, focusing specifcally on the general- izability and long-term maintenance of newly acquired skills taught through a com- petency-based approach, to novel opportunities for implementation. Training was conducted through two methods: in vivo training with clients versus role-play with peers. Both these types of staf training approaches are commonly used instructional practices in the feld of ABA.

Keywords Staf training · Competency-based training · Registered Behavior Technician · Pyramidal training · Behavioral skills training · Developmental disabilities · Role-play · In vivo

• Solandy Forte [email protected]

1 Endicott College, 376 Hale Street, Beverly, MA 01915, USA 2 Center for Children with Special Needs, 2300 Main Street, Glastonbury, CT 06033, USA

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Introduction

With the increase in the prevalence of autism spectrum disorder (ASD) over the years from 1 to 2 per 10,000 in 1980 to 1 in 59 today (Centers for Disease Con- trol and Prevention 2018), and the research supporting the efectiveness of early intervention and the use of ABA interventions (e.g., Myers and Johnson 2007; Howard et  al. 2005; Eikeseth et  al. 2007; Lovaas 1987), there has also been an increase in the demand for competent and qualifed behavior analysts (Hughes and Shook 2007). For the past 20  years, the feld of applied behavior analysis (ABA) has focused on the increase in the demand of ABA services and the lack of professionals trained in this area of expertise (Hughes and Shook 2007; Moore and Shook 2001). As noted by Dorsey et al. (2009),

The feld of applied behavior analysis (ABA) has experienced extraordinary growth in the number of practitioners as well as those seeking services. This change appears to be related to the explosion in the number of children diagnosed with pervasive developmental disorder/autism and the recogni- tion of the success of behavior analytic treatments (p. 53)

According to ChildStats.gov (the Federal Interagency Forum on Child and Family Statistic), there are currently 73.5 million children in the USA between the ages of 0 and 17 years old. Based on these statistics and the current preva- lence rates for Autism Spectrum Disorders (ASD), there are 1,079,411 children who meet the Diagnostic and Statistical Manual V standards for a diagnosis of ASD. According to the Behavior Analysis Certifcation Board (BACB®), there are 26,763 Board Certifed Behavior Analysts (BCBA®)/Board Certifed Assis- tant Behavior Analysts (BCaBA®) in the USA. Even with this density of qualifed professionals, and even if every Behavior Analyst in the USA worked exclusively with children on the autism spectrum, the ratio of clinicians to children with ASD would be 1:43. As a result, there is a growing demand for non-certifed individu- als such as instructional aides or direct-care staf, to receive the level of train- ing necessary for implementing behavioral interventions under the supervision of a behavior analyst. Recently the Behavior Analyst Certifcation Board (BACB) introduced its own credentialing of behavior technicians referred to as Registered Behavior Technicians (RBT®). In 2014, the BACB established a set of require- ments that individuals need to meet in order to be credentialed. These criteria have since been revised to include an examination requirement.

The requirements for the RBT credential are as follows: (a) be at least 18 years of age, (b) complete and pass a criminal background check, (c) have obtained a minimum of a high school diploma, (d) complete a 40-h, combined didactic and experiential training program that is aligned with the RBT® task list, (e) pass a competency checklist (demonstrate the ability to implement behavioral interven- tions and tasks in a role-play or in vivo format) as evaluated by the trainer, (f) pass the RBT® examination (requirement introduced in January 2015), and (g) pay all of the fees associated with the RBT® credentialing process. Once an individual is credentialed as an RBT, they must receive ongoing supervision for a minimum of

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5% of the hours spent per month implementing the principles of ABA in the work setting. In addition, they must apply for re-credentialing annually and adhere to the maintenance requirements which include meeting satisfactory completion of 12 out of 20 task list items on the RBT competency assessment, maintain ongo- ing supervision, and adhere to ethic requirements (BACB 2014).

Behavior analysts are faced with the challenge of executing a variety of job responsibilities to ensure that treatment derived from the principles of ABA is implemented with integrity and that these interventions are making a positive impact on the life of the consumer. It is often necessary for the implementers of behavioral technology (BCBA® or RBT®) to work across a variety of settings, including home, school, and community. Within these settings, it is common practice for behavior analysts to provide training to caregivers as well as direct-care staf, who may have limited knowledge and experience within the feld of ABA (Lerman 2009), but who are often charged with the implementation of behavioral technology with minimal supervision. As of April 3, 2017, the BACB reported that there were as many as 31,055 individuals credentialed as a RBT®. Once credentialed, the RBT® is not required to participate in continuing education activities to help to ensure that they are trained in contemporary behavior analytic interventions but are required to be supervised for a minimum of 5% of the hours they provide behavior analytic ser- vices per month (e.g., 1.5 h. for every 30 h. of direct service provided), one of which must be while delivering such services. Under such circumstances, an RBT® may be assigned to work alone in a 1:1 staf–child ratio, with a child diagnosed on the autism spectrum for 30-to-40-h per week in the child’s home, receiving a minimum of 1.5–2  h of supervision per week. Some have suggested that these provisions might not meet the needs for continued professional oversight and skill development (Leaf et al. 2016).

Specifc concerns have been raised about the RBT® training requirements (Leaf et  al. 2016), questioning whether the requirements were adequate enough to train staf to provide high-quality ABA services to a vulnerable population of individu- als served by professionals within the feld. Leaf et al. (2016) raised the following concerns: (a) the number of training hours required to become an RBT® are not suf- fcient enough to be “extensive”; (b) the content of the RBT® task list is incomplete, and the items are not operationally defned; (c) the assessment of knowledge and on-the-foor competencies are developed by the individual trainer, and there are no recommended measures for objectively determining if a trainee has, in fact, passed these competencies; (d) the majority of the on-the-foor competencies can be admin- istered using a role-play format; and (e) there has not been any evaluation to deter- mine the impact this credential will have on the cost of ABA treatment, the quality and integrity of services provided, and the impact on consumers receiving ABA ser- vices by an RBT® who may not have been trained sufciently. Leaf et al. stress the importance of developing standards for credentialing based on empirical data.

In response to this critique, Carr et al. (2017) noted that the BACB® adopts stand- ards for credentialing based on the recommendations from a group of subject matter experts (SMEs), and that the standards are reviewed and evaluated every 5 years. While these authors welcome researchers within the feld to evaluate the standards for RBT® credentialing, they admit that operationalizing and measuring the critical

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variables will be a difcult task. They also note that such research would need to be conducted across a variety of settings, as there most likely will be diferences that will impact the results. It seems that Carr et al. call for immediate research, which may contribute to the future revision of credentialing standards, to be conducted in this area and note that the research will take time to conduct and disseminate none- theless, they indicate that there is an immediate need for credentialing of nonprofes- sionals. Whether the decision to move forward before operationalizing and measur- ing this critical variable is a prudent one or not is beyond the scope of this study, but the points made by Leaf et al. (2016) and Carr et al. are certainly noteworthy.

In support of both the concerns raised by Leaf et al. (2016) and the suggestions made by Carr et al. (2017), the purpose of the present study was to conduct an initial assessment of a training package aligned with the RBT® task list utilizing a compe- tency-based training approach, specifcally evaluating the generalization and main- tenance of targeted skills using this training approach with paraprofessional public school staf. The study investigated in  vivo versus role-play training methods for providing competency-based training, including: the rate of skill acquisition of train- ees and the generalizability and maintenance of the trainees’ newly acquired skills.

There is a wealth of literature supporting the efectiveness of the competency- based training model utilized in this study for training staf in the implementation of behavioral techniques using its various teaching components (providing explicit directions, modeling, and feedback) as well as on the efects of staf training on client outcomes, consumer satisfaction, and future directions for the feld of ABA with respect to the study of competency-based training (Parsons and Reid 1995; Kratochwill and Bergan 1978; O’Reilly et al. 1992; Weinkauf et al. 2011; Lepage et al. 2004). Competency-based training packages typically include a didactic train- ing component that provides the trainee with information on a given topic related to intervention through a series of lectures. There are benefts and limitations for both the didactic and competency-based training models.

Competency-based training programs have been described for decades, primar- ily in the training of teachers and counselors (Bergan et  al. 1980) and have been expanded to encompass the training of direct-care staf working with individuals with developmental disabilities (Parsons and Reid 1995; Parsons et al. 2012). While there is a wealth of literature on competency-based training models, there is limited research evaluating the outcomes of competency-based training on the generalizabil- ity and long-term maintenance of skills acquired by direct-care staf.

Method

Setting

The present investigation was conducted in two classrooms located within a local public elementary school. The frst was an integrated preschool classroom and the second a special education classroom serving kindergarten to ffth-grade students. All training activities, including lectures, role-plays, and in vivo competency-based training, occurred within the same public school setting. The didactic training was

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delivered in the library media center, which was equipped with a laptop computer, projector, and screen for displaying PowerPoint presentations. The tables and chairs were arranged in a classroom style to allow participants to be able to view the mate- rial on the screen easily and take notes.

The role-play and in vivo training occurred within the same preschool integrated classroom and across special education classrooms in an elementary school setting (i.e., kindergarten to ffth grade). The preschool and special education classrooms were located on the frst foor of an elementary school. The preschool classrooms were arranged with designated center-based play areas, a carpet for circle time, tables and chairs, and a variety of materials and visual supports for individual, small, and large group instruction.

The special education classrooms included an instructional area for each student. Each instructional area was equipped with a desk or table and chair (appropriate for the student’s height), a storage shelf with materials organized into bins and folders, visual supports (schedules, choice boards, calendars, checklists, etc.), toys, and other tangible items used for reinforcement. Each student’s instructional area contained material that was individualized for his or her instruction (token economy system, lesson plans, data collection sheets, slant boards, timers, etc.).

Participants

The participants in this research study were instructional aides assigned to provide one-to-one individualized instruction based on the principles of ABA to children with a variety of developmental disabilities (including but not limited to ASD, Down syndrome, cerebral palsy, intellectual disability, as well as other related neu- rodevelopmental disorders). The participants were all full-time employees of the public school district. The educational training and experience of the participants varied relative to their knowledge of the principles of ABA and the implementation of behavioral strategies, and in their years working within educational settings. All instructional aides were at least 18 years of age and had a minimum of a high school diploma or national equivalent. Each instructional aide was assigned to implement skill acquisition and behavior reduction plans designed by a BCBA® to at least one student within the ABA program. All participants voluntarily consented to partici- pating in the research study. Their consent was documented via a formal consent form approved by a university Institutional Review Board (Title 45 Code of Federal Regulations Part 46), in which they were informed that they could withdraw their participation at any time and for any reason, with no penalty.

Prior to beginning the study, a questionnaire was distributed to each participant to gather demographic information as well as information related to past profes- sional experience within educational settings, prior training in ABA, and experience with individuals with special needs. The pool of participants was comprised of nine females, ranging in age from 26 and 65 years, all of whom completed the 40-h com- bined didactic and experiential training package aligned with the BACB® RBT® cre- dential task list. Five of the participants had high school diplomas, two had associ- ate’s degrees, and two had bachelor’s degrees.

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Seven of the participants reported having prior training in the implementation of ABA strategies (ranging from 3 to 10  years of prior experience), and all par- ticipants reported having training in a lecture-series format. Specifcally, fve of the participants reported receiving prior training in the implementation of discrete trial instruction and error correction procedures, and six participants reported receiving prior training in the delivery of reinforcement.

For this study, fve participants were randomly assigned to receive their experi- ential training through a role-play format, and four participants through an in vivo format. Participants were assigned to their respective groups for experiential training using a random number generator (random.org, 2016).

Design

A multiple baseline design (Baer et al. 1968) across participants was used to evalu- ate the efcacy of the role-play versus in vivo training on skill acquisition, generali- zation, and maintenance. A minimum of three skills was targeted for acquisition per participant (all participants received training across the same targeted skills). The targets were chosen based on recommendations from the Association for Behavior Analysis International—Autism Special Interest Group Consumer Guidelines.

The nine participants were randomly assigned across two groups (role-play vs. in vivo groups). Data for each skill were compared across training phases and across participants, thereby addressing the need for equivalence of skills. Data collection occurred during the following phases: baseline, post-didactic training probe, role- play or in vivo training, generalization, and maintenance. More specifcally, the data used to assess rate of acquisition for each skill were collected during the role-play and in vivo training phases of the study. The data used to assess the generalizabil- ity and maintenance of each skill were collected during the post-training phase of the study, after the participants had completed the didactic training for the specifc skill, and after the role-play or in vivo training phase had been completed by each participant.

Dependent Variable(s)

In order to assess the impact of the competency training method (role-playing vs. in  vivo competency training) competency scores were calculated (percentage of treatment integrity) from data collected for each participant using a task analysis for each skill. Again, there was a minimum of three targeted skills per participant. Collecting baseline data assisted the researcher in determining if the participant had already met profciency with regard to the targeted skill before the start of either direct training model.

The targeted skills selected for this study were based on recommendations from the Association for Behavior Analysis International—Autism Special Inter- est Group Consumer Guidelines, which identify the importance of training specifc behavioral techniques to implementers. These skills included but were not limited to the implementation of discrete trial instruction, error correction, prompting, and

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reinforcement (ABAI—Autism SIG, 2007). The skills targeted for acquisition in this study were also identifed on the RBT® task list developed by the Behavior Analyst Certifcation Board (BACB 2014).

The three skills targeted for training included the implementation of a discrete trial, an error correction, and the delivery of reinforcement. Each skill was objec- tively operationally defned using a task analysis outlining the steps for successfully completing each procedure, and these defnitions (steps) are described in Table 1.

Independent Variable(s)

Role‑Play Training

Participants randomly assigned to this group were presented with role-play scenarios for the opportunity to demonstrate each targeted skill. Components of the role-play training included providing: (1) the participant with explicit instructions on how to perform each skill, (2) a model, (3) feedback on performance, and (4) opportunities to practice each skill until they met criterion for mastery. A BCBA®, who was asked to play the role of a client, was instructed to look in the opposite direction of the par- ticipant (in order to provide the participant with an opportunity to gain the student’s

Table 1 The table below outlines each of the steps necessary for completing each of the targeted skills for acquisition (i.e., dependent variables)

Skill Steps of task analysis

Targeted skills for acquisition Implementation of discrete trial Clears area of extraneous materials

Places instructional material in front of student (in student’s view) Places materials in a feld size of 3 (when asked) Gains student’s attention (e.g., waits for eye contact or for student to

look at materials) Delivers correct SD

Provides clear and concise initial instruction Waits for student’s response (no more than 3 s) Delivers a light physical prompt within 3 s of observing incorrect

response Implementation of error correction Refrains from providing any reinforcement or comments about error

Provides light physical prompt to hand or elbow within 3 s of observing incorrect response

Rearranges materials on desk or table to prepare for representation of trial

Represents the original discrete trial (last trial presented where student made error)

Delivers reinforcement within 3 s of observing correct response Delivery of reinforcement Delivers verbal praise within 3 s of observing correct response

Uses an enthusiastic (not neutral) tone of voice when delivering verbal praise

Delivers token within 3 s of observing correct response Delivers tangible item for completion of token economy system (i.e.,

flled token board)

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attention) and respond incorrectly to the instruction given by the participant. Each training opportunity (i.e., trial) was novel to the participant. In other words, the par- ticipant was given a new scenario each time they were given the opportunity to prac- tice the skill. The length of the training session(s) varied depending on how many trials it took each individual participant to meet criterion for mastery (see results).

In Vivo Training

Participants randomly assigned to this group were presented with a real-life scenario for the opportunity to demonstrate each targeted skill with a client. Components of the role-play training included providing: (1) the participant with explicit written and verbal instructions on how to perform each skill, (2) a model, (3) feedback on performance, and (4) opportunities to practice each skill until they met criterion for mastery. The participants were each asked to demonstrate each skill with a client after being given a model and explicit instructions. The clients were asked to per- form a skill that was novel (in order to provide the participant with an opportunity to deliver a prescribed prompt). Similar to the role-play training procedure, each train- ing opportunity (i.e., trial) was novel to the participant. The length of the training session(s) varied depending on how many trials it took each individual participant to meet criterion for mastery (see results).

Procedures

Baseline

Participants were asked to perform each of the skills targeted for acquisition in a role-play scenario with a BCBA. Observations were conducted on each participant to obtain competency scores (percentage of treatment integrity) across a minimum of three sessions for each targeted skill. These data served as a baseline; therefore, no feedback was provided to the participants.

Post‑baseline

A 40-h, didactic training series was provided to each participant in a group format, comprised or all nine participants. The training series was developed such that the content was aligned with the BACB RBT® task list. For each of the targeted skills, a written topic-specifc lesson (within a didactic training format) was provided to each participant. The didactic training was delivered by a BCBA® in a lecture format using PowerPoint slides. The lessons were specifc to the skills targeted for training, and they included but were not limited to commonly used prompts, reinforcement, error correction, discrete trial instruction, incidental teaching, teaching and data col- lection protocols, task analysis, shaping behavior, and strategies for managing chal- lenging behavior.

Pre- and post-tests were administered to each participant to assess knowledge competencies before and after training. Each test included fve multiple-choice

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questions, directly related to the material outlined in the didactic training series. The purpose of this pretest was to identify any prior knowledge the participant had regarding the principles of ABA.

Training Phase

Competency-based training was provided to two training groups (role-play and in vivo) in an individual format for each participant. In the frst group, each partici- pant was trained individually through role-play to perform a targeted skill. The role- play training phase was then followed by a generalization and maintenance phase, where probe data were collected to assess generalization of the skill after the role- play training session. In the second group, each participant was trained individually with clients in vivo to perform a targeted skill. The in vivo training phase was then also followed by a generalization and maintenance phase exactly as outlined above. The participants did not move to the generalization and maintenance phases under either training paradigm until they had met criteria for mastery (a score of 100% across three consecutive trials) for each targeted skill.

Prior to the role-play or in vivo training, a BCBA® reviewed any protocols (e.g., skill acquisition or behavior reduction) with the participant specifc to the role-play or client’s instructional or behavioral protocol as this was a standard of treatment. The participant was then given the opportunity to ask questions.

Role‑Plays

The role-play participants moved into the role-play individual training phase after they had passed a topic-specifc quiz following the initial didactic training, which was delivered after the baseline phase.

After two trainers had conducted a demonstration of the targeted skills within a role-play situation, the participant was then presented with a scenario to perform the targeted skills (implementation of a discrete trial, error correction, or reinforce- ment). A trained BCBA® followed a script with explicit instructions on how to per- form during a role-play, and the participant was asked to demonstrate the targeted skill during the role-play scenario. Upon completing each role-play, feedback was provided, and the participant was asked to p

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