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Evaluating behavioral skills training and in-situ training to teach greeting skills to adults with developmental disabilities

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Title:
Evaluating behavioral skills training and in-situ training to teach greeting skills to adults with developmental disabilities
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English
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Smith, Shannan
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University of South Florida
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Social skills training
BST
Social skills
IST
Mental retardation
Dissertations, Academic -- Child & Family Studies -- Masters -- USF   ( lcsh )
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non-fiction   ( marcgt )

Notes

Abstract:
ABSTRACT: Previous research has demonstrated that behavioral skills training (BST) is effective in teaching social skills to individuals with developmental disabilities, but often the skills fail to generalize. One strategy to promote generalization has been the use of in situ training. In an effort to improve upon previous research BST plus in situ training was evaluated to teach greeting skills to adults living in a group home setting. The percentage of correct greeting responses was evaluated in a multiple baseline across participants design. Results showed that BST was only partially effective in teaching greeting skills to the participants. However, In-situ training resulted in a greater increase in correct greeting skills across all participants.
Thesis:
Thesis (MA)--University of South Florida, 2010.
Bibliography:
Includes bibliographical references.
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by Shannan Smith.
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Title from PDF of title page.
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Evaluating Behavioral Skills Training and In Situ Training to Teach Greeting Skills to Adults with Developmental D isabilities b y Shannan Smith A thesis submitted in partial fulfillment of the requirements for the degree of Master of Arts Depart ment of Child and Family Studies College of Behavioral and Community Sciences University of South Florida Major Professor : Raymond G. Miltenberger, Ph D Tim othy M. Weil, Ph D Kim Church, Psy D Date of A pproval July 12, 2010 Keywords: social skills training BST, social skills, IST, mental retardation Copyright 2010 Shannan Smit h

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i Table of Contents L IST O F TABLES ii L IST OF FIGURES iii A BSTRACT iv I NTRODUCTION 1 M ETHOD 9 Participants and settings 9 Dependent measures and assessment 12 Inter observer agreement 14 Experimental Design 14 Procedures 15 R ESULTS 18 D ISCUSSION 24 L IST OF REFERENCES 32 A PPENDICES 38 Appendix A: DV data collection sheet 39 Appendix B: Data sheet percentage of independence during r ole plays and trainings 40

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ii L IST OF TABLES T ABLE 1. Percentage of Correct Response during Behaviora l S kills Training Se ssions Rol e Plays 22 T ABLE 2. Percentage of Correct Greeting Responses durin g IST R ole P lays 23

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iii L IST OF FIGURES F IGU RE 1. Percent C orrect G reeting S kills D uring A ssessments A cross all P articipants and P hases 19

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iv Behavioral Skills Training and In Situ Training to Teach Greeting Skills to A dults with Developmental D isabilities Shannan Smith ABSTRACT Previous research has demonstrated that behavioral s kills training (BST) is effective in teaching social skills to individuals with developmental disabilities, but often the skills fail to generalize. One strategy to promote generalization has been the use of in situ training. In an effort to improve upon previous research BST plus in situ training was evaluated to teach greeting skills to adults living in a group home setting. The percentage of correct greeting responses was evaluated in a multiple baseline across participants design. Results showed that BST was only partially effective in teach ing greeting skills to the participants. However, In situ training resulted in a greater increase in correct greeting skills across all participants.

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1 Introduction R esearch has established that improving social s kills exhibited by individuals with developmental disabilities is important for improving quality of life, community inclusion, and normalization (Newton, Olsen, Horner, & Arid 1996; Trompenaars, Mastoff, Van Heck, De Vries, & Hodiamont, 2007; Whang, Fawc ett, & Mathews, 1984). Developmental disabilities are diagnosed by level of physical, cognitive, speech, language, or psychological impairment that may Yeargin Allsopp, & Lolla r, 2009). Individuals with disabilities also may demonstrate a lack of social skills and inappropriate behaviors resulting in decreased peer acceptance, reduced opportunities, negative public opinion, and feelings of loneliness or isolation (Elliott & Gre sham, 1993; Gresham, 2002; 1986). Therefore, it is necessary to investigate effective ways to teach individuals with disabilities the social skills required to live a more norm al and less stigmatizing life. including instructions, modeling, rehearsal, and feedback (also called behavioral skills training; Miltenberger, 2008) has been used successfully to teach skills to individuals with developmental di sabilities (Morgan & Salzberg, 1992; Storey & Gaylord Ross, 1987; Wildman et al. 1986). Instructions are used to describe the behavior that will be trained and what the participant is required to say or do. The trainer then models what the desired behavi or looks like when exhibited correctly. Rehearsal is used to allow the

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2 participant opportunities to practice the skill that the trainer previously modeled. Usually the participant must practice until he or she reaches a specific criterion for mastery or until a specific time period has ended. Positive reinforcement (most often praise) is delivered for correct responses. Feedback (further instruction or prompting) is delivered when the participant delivers an incorrect response. Matson and Senatore (19 81) compared the effectiveness of traditional psychotherapy, social skills training (SST), and no treatment with 32 adults diagnosed with mild to moderate developmental disabilities. Appropriate and inappropriate verbal statements were identified as the target behaviors. Training consisted of either 5 weeks of SST or traditional psychotherapy, respectively, conducted in a group therapy room at a local clinic. Social skills training consisted of instructions, modeling, rehearsal, and feedback. Results o f this study indicate that the mean frequency of appropriate verbal statements was higher in the SST group than in the traditional psychotherapy or no treatment conditions. Pertinent limitations of this study are discussed. The SST program was conducte d in a clinical setting rather than in the environment in which the target behaviors occur. Training in a clinical setting rather than in the natural environment often limits the stimulus control of the behavior being trained (Stokes & Baer, 1977). Altho ugh this study illustrates the value of SST, improvements are needed in the area of maintenance and generalization. Future

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3 research would benefit from combining SST with assessment of generalization and specific strategies to promote generalization in the natural environment. In a similar study, Gaylord Ross, Haring, Breen, and Pitts Conway (1984) evaluated SST plus the use of an object to help two autistic individuals learn to initiate and have longer conversations with their typically functioning peers. Objects used to facilitate conversation included a Pac Man video game, Sony Walkman, and a package of chewing gum. Training took place in a special education class and participants were later evaluated in the courtyard of the high school, where both typi cally functioning and developmentally disabled students gathered during brea k times. Both participant s possessed a limited verbal repertoire and often exhibited problem behaviors during this time. During training was provided. In the second phase the teacher delivered the same verbal cue and gave the participant one item to take into the courtyard (object only condition). During the third condition, participants were taught how to use each object (i.e. turn on the machine, press start, make Pac Man move up, necessary to interact with others in the courtyard using the selected object. Instructions, model ing, rehearsal, and feedback were used to teach the participants how to use an object to initiate conversations with their typical ly functioning peers. Data were collected on the frequency and duration of social interactions.

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4 Results indicated that both participants demonstrated an increase in the percentage of correct responses completed in the social skills task analysis across all objects. Additionally, the number of cumulative seconds of interactions increased for both participants during the SST co nditions only. Although this study did not refer to the use of in situ assessment, the authors did conduct in which social interactions were lacking (courtyard of the hig h school). In addition, SST procedures (verbal/physical prompts, feedback, and positive reinforcement) were effective in teaching the participants the correct social response. Chung et al. (2007) used peer mediated SST to teach social skills to individu als with developmental disabilities. Peer mediated training involves the use of individuals that are more similar to the participants to teach skills, initiate conversation, or respond to initiations of the participant. Peer mediated training is more lik ely to promote generalization of the skills with other non trained peers, therefore possibly increasing the social interactions with many peers. Chung et al. (2007) evaluated the use of a shorter, adapted version of Thiemann and Goldstein (2001) SST progr am to teach communication skills to children diagnosed with autism. This program included a welcome statement, instructions, rehearsal, video feedback, and positive reinforcement to teach participants appropriate verbal statements. Typical ly functioning peers were trained to conduct group social skills training to four children with autism spectrum disorder. The percentage of appropriate and inappropriate verbal

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5 responses was measured and later coded for evaluation. Results of this study indicated that 3 out of 4 participants exhibited an increase in appropriate verbalizations and decrease in inappropriate verbalizations. However, training did not occur individually in the natural environment, but rather as a group in a convention center. The validit y of the results of this study may be increased by conducting individual training and evaluating the results in the environment in which the problem behaviors occurred. In addition to the SST approaches described in the previous studies, other forms of s ocial skills training have been demonstrated in the literature. Peer mediated therapy and self management have been used to increase McMorrow, Bittle, & Ness, 1986; Kamps et al., 2002; Matson & Earnhart, 1981; Stewart, Van Houten, & Van Houten, 1992). Peer mediated therapy and self management utilize typically functioning peers trained to prompt social skills or self management procedures such as the participant learning to recor d and rate his/her own behavior. These techniques have been used in an attempt to improve generalization of social skills. Video modeling has been effective to teach social initiation and reciprocal play skills to young children with autism (Nikopoulos & Keenan, 2004). Social stories that include information regarding appropriate social responses have been used to increase eye contact, smiling, Disorder (Scattone, 2008).

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6 Althou gh these studies and others (Eckert, 2000; Petursdottir, McComas, McMaster, & Horner, 2007; Sim, Whiteside, Dittner, & Mellon, 2006) have shown that SST can be effective, this research is characterized by limited assessment of generalization and limited us e of strategies to promote generalization. Research by Lumley et al. (1998) demonstrated a strategy for assessing generalization in the natural environment. In this study Lumley conducted in situ assessments in which sexual abuse prevention skills of wom en with mild MR were assessed in assessed. In this way, the authors conducted a valid assessment of generalization of the skills in the natural environment in which they could be cert ain the skills were not under the stimulus control of the training stimuli or the presence of the trainer. By assessing the skills with in situ assessments, Lumley et al. (1998) showed that the skills demonstrated in training sessions did not generalize t o the natural environment. Across similar studies evaluating SST, the training was initially effective in teaching social skills but was not sufficient to promote generalization of these skills in the natural setting (Foxx, McMorrow, & Mennemeier, 1984; O Miltenberger et al. (1999) expanded on the literature by conducting behavioral skills training and evaluating in situ training as a strategy to promote generalization. In this study sexual abuse prevention skills were trained to 5 women diagnosed with mild to moderate mental retardation living in a group home setting. Four target responses were trained. In response to a sexual abuse lure delivered by a confederate posing as a staff member, the participant

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7 1) does not agree to eng age in or comply with sexual request, 2) says no or uses other verbal speech to refuse request, 3) leaves the situation or tells the confederate to leave, and 4) reports the incident to staff. Praise and food coupons were delivered for correct responses Behavioral skills training (BST) continued until all women could accurately and independently respond to the situ assessments were conducted one week after BST ended. In situ training was provided to those participan ts receiving less than the 4 maximum points that could be earned for each scenario. During in situ training, a trainer hidden from the view of the participant stopped the interaction between the participant and the confederate and provided corrective feed back. Training consisted of asking the participant what the confederate had asked her to do and how she responded to this request. Additionally, participants were told the correct response, observed a model of the correct response, and rehearsed the skil l until it was exhibited independently during 2 role plays. In situ assessments were again conducted three days after the last assessment. In situ training occurred until each participant received the maximum 4 points for three consecutive assessments. Miltenberger et al. (1999) established that BST alone was not enough to setting. Four to eight in situ training sessions were conducted in order for the participants to i ndependently respond to inappropriate sexual requests in their home. This study cites the importance of in situ training as an addition to BST in teaching social skills to individuals with developmental disabilities.

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8 Generalization of the desired skill w as more likely when BST and i n situ training occurred. Additional research has also found BST plus in situ training to be successful in teaching children safety skills such as prevention of gun play (Miltenberger et al., 2005 ), abduction prevention skil ls (Johnson et al., 2005; 2006), and avoidance of hazardous chemicals (Dancho, Thompsen, & Rhoades, 2008). In each of these studies in situ training enhanced the effectiveness of BST and promoted generalization. The purpose of this study was to evaluat e a social skills training package including instructions, modeling, rehearsal, and feedback plus in situ training for teaching greeting skills to participants diagnosed with mild to moderate mental retardation. Staff identified greeting skills to be a pa rticularly important social skill for these residents as they engage in several inappropriate behaviors when new individuals or consultants visit their home. Inappropriate behaviors such as divulging personal information, requesting immediate attention, a sking inappropriate questions, interrupting, getting too close to the visitor, and other attention seeking behaviors were identified as undesirable and stigmatizing. More appropriate greeting skills may lead to increased social interactions and greater ac ceptance of these individuals.

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9 Method Participants and Setting Seven p articipants diagnosed with mild to moderate mental retardation volunteered to take part in greeting skills training. The foll owing selection criteria w ere applied to determine whic h clients were selected for t reatment. Participants included in this study were able to understand a minim um of four simple requests, had the opportunity to interact with others who visit their h ome or work setting, and had the ability to remember a simple scripted statement and execute it. All participants were clients at a non profit agency that provides residential services to adults with developmental disabilities. Three clients from one group home and four from another were selected to participate i n this study. Each group home accommodate d up to 6 clients and wa s located in the community. Participants in this study either ha d a bedroom to themselves or ha d one roommate. The primary goal of the agency wa s to help these individuals achieve their ma ximum level of independence in their day to day lives. For some of these clients this mea nt living in a group home their entire life whereas others may advance to living on their own with limited staff assistance. It is important to note that many of the individ uals living at the agency we re under court order having previously been convicted of various sexual crimes against children. This fact often limit ed their freedom to decide where they would like to live and work. Bob wa s a 49 year old man diagnos ed with a primary disability of mild mental retardation and secondary diagnosis of depression. Bob ha d a history of

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10 engaging in inappropriate sexual behavior, violation of probation, physical aggression, and verbal aggression. In the past Bob graduated s ex offender therapy and lived in his own home but returned to jail after violating his probation. After leaving jail Bob returned to living in a group home. Due to the severity of his behaviors, Bob require d 24 hour staff supervision. Bill wa s a 40 year old man diagnosed with a primary disability of moderate mental retardation and a seconda ry disability of cerebral palsy. Bill also had a traumatic brain injury. Bill ha d a history of inappropriate sexual behaviors, inappropriate social behavior, physical aggression, verbal aggression, and self abuse. Bill require d 24 hour supervision because he continue d to engage in problem behaviors and pose d a risk to the community. Kurt wa s a 26 year old man diagnosed with mild mental retardation and autism. Kur t ha d a history of inappropriate sexual behavior, inappropriate social behavior, and stealing. The last incident of inappropriate sexual behavior resulted in Kurt s arrest, incarceration, and current placement in a group home. Kurt also require d 24 hour staff supervision but in the future hopes to move into a place of his own with less support. Luis wa s a 31 year old man diagnosed with mild mental retardation, anxiety, and epilepsy. Luis ha d an extensive history of inappropriate sexual behavior. He was court ordered to his current residential facility for previously engaging in a Lewd and Lascivious Act against a minor. Luis require d 24 hour staff supervision due to the severity and high risk of his behaviors.

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11 Mike wa s 41 year old man diagnosed with mild to moderate mental retardation and poly substance abuse. Mike ha d a history of engaging in substance abuse, stealing, and inappropriate social behavior. The se problem behaviors require d Mike to live in a 24 hour supervised intensive residential set ting and prohibit ed him from living independently and successfully in the community. Robert wa s a 39 year old man diagnosed with mild mental retardation. Robert ha d a history of engaging in inappropriate sexual behaviors (stealing girls undergarments, in appropriate interactions with women and minors) and inappropriate social behaviors (i e. verbal aggression, inappropriate and excessive complaining, bossing others). He continue d to display dangerous inappropriate sexual behaviors (such as breaking into a neighbors home to hide in the closet of a young child, which resulted in his arrest but no access to the child) as well as a high frequency of disruptive social behaviors. For these reasons, Robert require d 24 hour staff supervision. Lastly, Jason wa s a 28 year old man diagnosed with mild mental retardation. Jason ha d a history of inappropriate sexual behavior with children. Due to charges of sexual assault on a child, he wa s court ordered through the Department of Children and Families to remain in a n intensive residential facility with 24 hour supervision. In situ assessment sessions and training sessions occur red at the group home front doo r

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12 Dependent Measures and Assessment Behavior analysts employed at the research site were asked to ide ntify a social skill that would be important for the ir clients to learn. They identified that many of the clients needed training to learn appropriate greeting skills. Specifically, the clients fail ed to engage in appropriate greeting responses and often engage d in undesirable behaviors (e.g., divulging personal information, asking inappropriate questions, interrupting, being within length of the visitor, or engaging in other inappropriate target behaviors that are operationally defined below) when someone enter ed the group home. The dependent variables for this study were the percentage of cor rect greeting responses exhibit ed when an unknown person knocked at the door of the group home. The person knocking at the door of the group home was a rese arch assistant, hereafter referred to as the confederate The correct greeting responses were recorded for 30 sec after the participant made initial contact with the confederate either by a udio recording or completion of data sheet by another confederate present at time of assessment Correct greeting responses include d . that ______ is at the door. These data were presented as the percentage of correct greeting responses. Audio recordings and confederate documentation w ere evaluated and scored after the interaction was completed. The confederate used scripted response upon entering the group home.

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13 t he same. If the participant said his or her n ame. If the participant said named the sta ff on d uty. If the participant engaged in any other verbal interactions (inappropriate behavior), the confederate stoo d there and smile d until the 30 sec had elapsed. If the participant correctly sought out group home staff to info rm the staff of a visit or, staff respond ed you for Staff members wo rking at each group home were trained to respond to the situ assessments. During tra ining sessions the trainers provide d enthusiastic praise following each of the er participant responses were ignored. Staff and confederates were also trained on filling out the data sheet. Correct greeting responses were recorded d uring in situ assessments. In situ assessments occu rred in the natural environment, in thi s case when a confederate knocked at the door of knowledge that an assessment was occurring Recording of the interaction w as completed by either an audio recording or a data sheet completed by a second confederate/staff present during the assessment.

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14 Interobserver Agreement Research assistants and the first author observe d and score d greeting responses from audi otape and duplicate data sheets in at least 76 % of sessions across phases. Interobserver agreement was calculated for greeting responses by dividing the number of agreements on the 5 responses by the number of agreements plus disagreements, multiplied by 100. IOA was 98.6% (range 80 to 100) for Bob, 100%, for Bill, 100%, for Kurt 97% (range 80 to 100), for Luis, 97% (range 80 to 100), for Mike, 98% (range 80 to 100), for Robert, 100%, and for Jason, 98% (range from 80 to 100). Experimental Design A multiple baseline ac ross participants design was employed to assess program effectiveness. The sequence of phases include d baseline, behavioral skills training ( B ST), and i n situ training (IST). Participants had either 4, 5, 6 or 8 baseline assessments and then participated in 3 B ST sessions In situ assessments occur red within two days following each B ST session. I f a participant did not achieve 100% correct greeting responses during the in situ assessment s following BST, in situ training was initiated

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15 Pro cedure Baseline. responses were observed during baseline without training or feedback. Participants were also blind to the purpose of the study. reviewed from audio taped interactions or written documen tation collected by a secondary confederate or staff present during assessment. Responses were scored as the percentage of correct greetings. Behavioral S kills T raining During the initial training s essions each participant was told that he will be pra living in the same home were trained together and assessed separately. A role played scenario involving a guest entering the group home was presented, the approp riate greeting responses were described and modeled, and the participants rehearse d the skills with feedback 10 times each during three training sessions. Any inappropriate participant responses were ignored. The percentage of correct greeting skills responses was assessed for each participant during in situ assessment sessions within two days of the training session. Training bega n wit h instructions. The trainer describe d the f ive greeting skills to use when a person enters the group home. After providin g instructions, the trainer model ed the correct greeting. In a role play, the trainer had a participant play the role of a person entering the group home where the trainer walked up to the person and exhibit ed the greeting response. The staff in the group home th e n thank ed the trainer After the partici pant observed the model,

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16 the trainer ask ed the participant to describe the greeting respons e he just observed. The trainer provide d pra ise if the participant described the greeting responses correctly and gave f eedback if the participant failed to identify any of the greeting resp onses. After the participant correctly identified the greeting re sponses, the participant was given an opportunity to rehearse the skills. The trainer ask ed the participant to practice these skills in a role play scenario. The participant play ed the role of the greeter and the trainer play ed the role of the person entering the group home. The trainer knock ed on t he door and the participant walk ed up to the trainer and deliver ed the greet ing responses. The trainer provide d prai se to the par ticipant as he correctly engaged in each greeting response. The staff thank ed the participa nt if he appropriately announced the nce. If the participant failed to engage in an y of the greeting skills within three seconds he i mmediately received correc tive feedback. The trainer first praise d the participant for any greeting responses that were role played correctly. Incorrect ver balizations or behaviors were followed with the trainer describing the correct greeting sk ills. The participant was asked to identify the correct greeting respo nses. After the participant correctly ident ified the five greeting responses, the participant rehearse d the skills again. The trainer provide d praise to the participant as he stated each co rrect greeting respons e. Rehearsal and feedback continue d until each participant had the opportunity to rehearse the greeting skills ten times.

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1 7 The par role played s cenarios during training were recorded as the perce ntage of independent greeting responses and are reported in table 1 Afte r the participant had engaged in each training sessio n, an in situ assessment was conducted in the same manner as in baseline The in situ assessment was conducted at le ast one to two days after the training session. After the in situ assessment follo wing the third training session was completed and the participant did not engage in the corr ect greeting response, in situ training was provided. In situ training During the last in situ assessment following BST, if the correct greeting was not used the trainer (who was unseen up to that point) showed up, interrupt ed the interaction and told the participant he had to practice the correct gre eting response. The trainer model ed the gr eeting responses and then had the participant practice the skills. If the participant performed the skills correctly, he receive d pra ise. Incorrect responses were immediately interrupted by further instructions and modeling until correct. If other inapprop riate responses occur red the staff interrupted the responses and redirect ed the participant to the g reeting response. Training continue d until five rehearsals of the correct greeting responses occur red consecutively. In situ assessment (followed immediat ely by in situ training if needed) continue d until the person could consistently respond with the correct greeting response s

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18 Results Figure 1 shows the percentage of correct greeting responses for all participants across baseline (BL), behavioral skills training (BST), and in situ training (IST) phases. Overall, the participants scored a mean of 1 3 % correct greeting responses during baseline. All participants demonstrated a moderate increase in percentage of correct greeting skills after BST sessions. Specifically, participants scored a mean of 55 % correct greeting responses during assessments that followed BST sessions. After the last BST session, 6 of 7 participants required in situ training. S ubstantial improvements in participant greeting response s were noted for all but one p articipant afte r receiving between 1 to 10 in situ trainings. in situ assessments. Bill and Bob did not exhibit any of the correct greeting responses during baseline wi th each obtaining 0% correct responses Both participants demonstrated a mean of 53% correct greeting responses during assessments that followed BST sessions. Following IST, Bob e x hibited 100% correct greetings variable, although he achieved a mean of 87% correct greeting responses during the last three IST assessments.

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19 Percentage of correct greeting skills Sessions

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20 Kurt had a mean of 20% correct gre eting responses during BL. He also demonstrated an increase to 64 % correct during BST assessments He later refused to participate in IST sessions and was withdrawn from the study Lui BL data w ere low and stable receiving an average of 27% correct greeting responses Following BST sessions Luis exhibited an aver age of 53% correct greeting responses. During IST Luis maintained an average of 97% correct responses. In addition, Luis exhibited 100% correct greetings during the last 4 consecutive IST assessments Robert also reached a stable baseline within 6 ass essments with a mean of 10% correct greeting responses After 3 greet ing responses increased to a mean of 4 7% during assessments correct greeting responses also increased to a mean of 88% correct during the IST p hase Lastly, he received consecutive scores of 100% correct greetings during the final two assessments Mike exhibited a mean of 14% correct greeting skills during baseline. D ata collected following BST sessions established that Mike performed the co rrect greeting responses a mean of 35% correct during assessments During in situ training Mike exhibited a 20% increase in correct greeting responses (mean of 55% correct greeting responses). Moreover, Mike reached 80% correct greeting responses duri ng session twelve However, assessment data that followed this session decreased to a mean of 40% correct greeting responses (see discussion).

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21 During baseline, Jason initially showed a low and stable rate of correct greeting responses. Following the thi rd BL session, Jason exhibited an increase in correct greeting responses with the last half of baseline stabilized at a mean of 50% (last 4 sessions) BST was then implemented. Jason exhibited a mean of 80% correct greeting responses during a ssessments t hat followed BST. Because h e exhibited the correct greeting response during the last 3 consecutive BST as sessments, IST was never implemented. Table 1 and Table 2 (on pages 22 23 ) show all participants percentage of independence in demonstrating the fi ve greeting skills during BST and IST role plays.

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22 Table 1 Percentage of Correct Response during Behavioral Skills Training Sessions Role Plays. ___________________________________________________________________________ _________________ _____________ __Sessions ___________________________ _________ Participant 1 2 3 ___________________________________________________________________________ Bob 100 100 100 Bill 0 20 80 Kurt 80 100 100 Robert 90 80 80 Luis 80 80 80 Mike 60 80 80 Jason 80 80 100

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23 Table 2 Percentage of Correct Greeting Responses during IST role plays. ________________________________________________________________________ ________________________Sessions___________________________________ ______ Participant 1 2 3 4 5 6 7 8 9 10 11 12 ________________________________________________________________________ Bob 100 * Bill 83 100 100 100 71 100 100 100 100 100 Kurt Participant withdrew from study during first IST session. Robert 100 100 Luis 100 * 100 Mike 71 75 75 100 100 Jas on 100 100 100 100 * * Scored 100% during assessment therefore no IST was implemented.

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24 Discussion This study showed that BST increase d correct greeting skills for all participants. However, greeting sco res remained at a mean of only 55 % correct after BST. During the in situ training condition, all participants correct greeting respon ses increased to a mean of 79 %. BST did teach participants the correct skills during training (Table 1) but th ese skills did not generalize when assessed in the natural environment. In situ training was required for all but one of the participants to engage in the correct greeting responses outside of BST sessions. The data suggest that if the participant is not able to receive instruction, practice, and feedback at the time the behavior occurs (in situ training) then it is un likely the skill will generalize to the natural context of a visitor at the door T he exception was Jason who reached criteria for mastery after t hree BST sessions and six assessments. This may have been because Jason seemed to eventually discover that when cert ain persons came to the door he would likely be assessed. Contributing to this potential reactivity effect was the fact that some RAs had t o do more than one assessment for Jason, so it is possible that he recognized them and was cued to the assessment. The participant s in this study had various levels of functioning. Someone with a higher functioning level was able to learn and maintain the skills faster than those with a lower functioning level. For instance, Bob (diagnosed with mild MR) was able to maintain correct greeting skills after three BST sessions and only one in situ training. However, Bill (diagnosed with moderate MR and tra umatic brain injury ) required seven in situ trainings and was never able to

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25 reach 100% correct greeting skills during three consecutive assessments In fact his performance actuall y dropped to nearly 0% correct greetings between sessions 10 12 After the fifth IST assessment Bill received a booster session of BST and his performance increased again to a mean of 76% correct greetings I ncreasing the number of BST sessions may allow low er functioning clients the ability to successfully learn the skills. Th erefore, future researchers may want to extend the number of behavioral skills training sessions (5 10 BST sessions) or return to BST if the participant is unable to reach performance criteria. In addition, the duration of time between assessments and t rainings seems to have a ffected some of the participants scores. For instance, Bill received two in situ training sessions and then scored 100% during the third in situ assessment Because he made no errors, he did not receive in situ training after that assessment By the time he was assessed the fourth time at least 2 weeks had passed without receiving any performance feedback. Because Bill is diagnosed with moderate mental retardation and TBI the longer time between trainings a lower level of cogni tive functioning and lack of reinforcement may have been responsible for the rapid decrease in correct greeting skills in the IST phase In the future, in situ trainings that occur in more rapid succession may result in a higher percentage of correct gree ting skills during follow up assessments. Conducting in situ training and assessment more closely together in time is likely to result in the participant engaging in the correct behavior(s) during assessment because they are more likely to remember the skill The duration of

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26 time between IST and assessments ranged from one day to approximately three weeks. The data suggest that if a participant receives training or feedback within close proximity to an assessment, he is more likely to exhibit the corre ct response during assessment. Moreover, a high level of reinforcement following 100% correct role plays or assessments may make it more likely that the participant will remember the ck of consistent positive reinforcement. When a participan t scored 100% during the in situ training phase, he did not rec eive any training or feedback from the researcher I t was not until he scored below 100% that he received in situ training (with the e xception of Mike) Staff were supposed to provide praise if the participant exhibited the correct greeting response during an assessment. This did not consistently occur and sometimes resulted in no positive reinforcement when a participant said the corr ect greeting response Due to the fact that he seemed to be receiving more attention for incorrect greetings than for correct greetings (due to in situ training), Mike was told during session 14 that if he scored 100% correct greeting responses, then he w ould receive a short duration of reinforcement (time with the researcher) Thereafter, when he made mistakes during an assessment, training was brief, but when he got 100%, the researcher spent time with him as a reward. s score improved t o 80 % durin g the following assessment (100% during final assessment) During session 10, Mike exhibited 0% correct greetings. At the time of the assessment Mike was eating dinner and got up to answer the door. It

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27 appeared that he wanted to get back to his meal and may have performed better under different circumstances. During BST, Robert s percentage of correct greeting responses demonstrate d a possible upward trend in the data (2 data points at 40% followed by 1 at 60%) Assessments should have continued unti l his data had stabilized in the BST phase before proceeding to the in situ training phase. It is possible that his percentage of correct greeting responses may have continued to rise in BS T Alternatively, it is possible that the greeting responses could have fallen back to 40% or less. Regar dless, following 2 in situ training sessions, he achieved 100% correct responding and maintained at 100% for 3 of 4 assessments. Jason received eight BL assessments with the last 4 sessions stable at 50%, before mo ving on to BST sessions. During BST, Jason achieved a mean of 80% correct greeting skills within 6 assessments. As previously discussed, Jason seemed to have identified the fact that when specific individuals knocked on the door, the researcher would sho w up and pr ovide training. The use of some of the assessments. It appeared that Jason reached the performance criteria more rapidly than the other participants because he may h ave been able to determine when assessments occurred. In addition, his ability to state the correc t greetings during assessment may have been positively reinforcing I n the past Jason has been eager to do well during the assessment of skills learned

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28 wit hin a BST format As a result, it seemed that making correct responses during BST had become a conditioned reinforcer, perhaps contributing to his success. In situ training is considered effective because the trainer is catching the participant in the mo ment that he is exhibiting the skills incorrectly or failing to exhibit the skills at all and providing immediate feedback. If making an error and receiving training to correct it is aversive, then correct responding in future assessments should be negativ ely reinforced by avoiding in situ training. However, e scape from corrective feedback seems to be more successful as a reinforcer (more likely to be negatively reinforcing) when the participant s believe the behavior they are exhibiting will negatively affe ct them. For instance, receiving corrective feedback regarding gun safety skills or abduction prevention skills m ay be taken more seriously as the skills are related to a threat of bodily harm or death. The use of greeting skills occurs in a far more com mon situation (someone at the door) and is not associated with the same threat of harm. As a studies showing the effectiveness of in situ training ( Miltenberger, et al. 2005; Milt enberger, et al. 1999; Lumley et al. 1999). It should be noted that the participants in this study share a common goal of wanting to live on their own. Many of the participants are sex offenders and should know how to greet unknown visitors at their doo r. In this study, the participants only received feedback about their incorrect greeting responses. It may be helpful to address the consequences of letting someone in your house that could cause harm risk

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29 of being taken advantage of or put the partici pant at risk for criminal behavior (for this population of participants). In situ training involves the repetitive practicing of a behavior in the moment that it occurs. Some of the participants seemed to feel uncomfortable repetitively practicing thes e skills during in situ training. Persons running in situ trainings with clients may have more success if they have a history of working with the individual and thus the individual is more comfortable with the trainer In such cases, getting it right and getting approval may be more likely to be a reinforcer for the individual Kurt initially was hesitant to participate in the study, citing that he really of wanting to live on hi s own and receiving assurance that his involvement in the study had no effect on the outcome of his future, he agreed to participate in BST. Kurt refused to take part in the first BST session but later complied and did well. He seemed very uncomfortable practicing greeting skills at the door of the group home (where other clients could be watching). The researcher attempted to accommodate for this by trying to get staff to distract other clients during trainings with Kurt. This was not always successful and Kurt appeared uncomfortable and did not take part in all of the role plays. Du ring the first in situ assessment Kurt stated 3 out of 5 correct greeting responses. When approached by the researcher to conduct in situ training, he stated that he did not want to answer the door this way. During this assessment, Kurt independently told the researcher the correct greeting skills two times. After he was asked if he wanted

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30 that Kurt would be withdrawn from the study as he clearly did not want to participate. The data suggest that in correct greeting response. However, there were several limitations that may make it diff icult to use this method of teaching skills in the natural environment. Learning greeting skills required the researcher to plan to have confederates that are unknown to the participant knock on their door to conduct assessment s Because of this, severa l confederates were needed to execute the research. In order to successfully implement in situ training, several resources must be available. This may be a problem for a researcher that cannot find enough confederates or an agency that is already under staffed. In addition, the nature of in situ training is that the participant does not know when he will be assessed. In this study, several of the participants lived in the same house. This made it difficult to plan assessments in which the researcher would not be discovered by the participant. For this reason, the decision was made to assess only 2 participants from the same home per session Moreover, because confederates were limited the time between two minutes to an hour apart. The time between assessments was determined by the staff working in the group homes. This required that at least two staff was working in the house to distract t he second participant and come up with reasons to ge t th e other par ticipant to answer the door. In situ training may not be practical to teach skills that require a new and different person to conduct each assessment.

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31 Overall, participants exhibited an average of 55% correct greeting skills during BST. Although this was a considerable increase from baseline, six out of seven participants required in situ training to increase the percentage of correct greeting skills even further. Jason was the only participant to acquire the correct greeting skills before IST was implem ented. These results are consistent with previous research demonstrating the value of BST and IST for teaching skills to individuals with disabilities. Future research should evaluate BST and IST for other socially valid social skills needed by individual s with disabilities to become more independent and accepted into the community.

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32 List of References: Chung, K. M., Reavis, S., Mosconi, M., Drewry, J., Matthews, T., & Tasse', M. J. (2007). Peer mediated social skills trainin g program for young children with high functioning autism. Research in Developmental Disabilities, 28 423 436. Dancho, K.A., Thompson, R.H., & Rhoades, M.M. (2008). Teaching preschool children to avoid poison hazards. Journal of Applied Behavior Anal ysis, 41(2), 267 271. Duan, D. W., & O'Brien, S. (1998). Peer mediated social skills training and generalization in group homes. Behavioral Interventions, 13 235 247. Eckert, S.P. (2000). Teaching the social skill of accepting criticism to adults with developmental disabilities. Education and Training in Mental Retardation and Developmental Disabilities, 35(1), 16 24. Embregts, P.J. (2000). Effectiveness of video feedback and self management on inappropriate social behavior of youth with mild mental r etardation. Research in Developmental Disabilities, 21, 409 423. Elliott, S.N. & Gresham, F.M. (1993). Social skills interventions for children. Behavior Modification, 17(3), 287 313. Foxx, R.M., McMorrow, M.J., & Mennemeier, M. (1984). Teaching social /vocational skills to retarded adults with a modified table game: an analysis of generalization. Journal of Applied Behavior Analysis, 17(3), 343 352.

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33 Foxx, R.M., McMorrow, M.J., Bittle, R.G., & Ness, J. (1986). An analysis of social skills generalizati on in two natural settings. Journal of Applied Behavior Analysis, 19(3), 299 305. Gaylord Ross, R. J., Haring, T. G., Breen, C., & Pitts Conway, V. V. (1984). The training and generalization of social interaction skills with autistic youth. Journal of App lied Behavior Analysis, 17 229 247. Gresham, F.M. (2002a). Best practices in social skills training. In A. Thomas & J. Grimes (Eds.), Best Practices in School Psychology IV (pp. 1029 1040). Washington, DC: National Association of School Psychologists. Johnson, B.M., Miltenberger, R.G., Egemo Helm, K., Jostad, C.M., Flessner, C., & Gatheridge, B. (2005). Evaluation of behavioral skills training for teaching abduction prevention skills to young children. Journal of Applied Behavior Analysis, 38, 67 78. Johnson, B.M., Miltenberger, R.G., Knudson, P., Egemo Helm, K., Jostad, C., & Langley, L. (2006). A Preliminary Evaluation of Two Behavioral Skills Training Procedures for Teaching Abduction Prevention Skills to School Children. Journal of Applied Behavi or Analysis, 39, 25 34. Kamps, D., Royer, J., Dugan, E., Kravits, T., Gonzalez Lopez, A., Garcia, J., Carnazzo, K., Morrison, L., & Garrison Kane, L. (2002). Peer training to facilitate social interactions for elementary students with autism and their pee rs. Council for Exceptional Children, 68(2), 173 187.

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34 Lumley, V., Miltenberger, R.G., Long, E., Rapp, J., & Roberts, J. (1998). Evaluation of sexual abuse prevention program for adults with mental retardation. Journal of Applied Behavior Analysis, 31, 9 1 101. Matson, J.L., & Earnhart, T. (1981). Programming treatment effects to the natural environment: a procedure for training institutionalized retarded adults. Behavior Modification, 5(1), 27 37. Matson, J. L., & Senatore, V. (1981). A comparison of t raditional psychotherapy and social skills training for improving interpersonal functioning of mentally retarded adults. Behavior Therapy, 12 369 382 Miller, M.J., Lane, K.L., & Wehby, J. (2005). Social skills instruction for students with high incidenc e disabilities: A school based intervention to address acquisition deficits. Preventing School Failure, 49(2), 27 39. Miltenberger, R.G., Gatheridge, B.J., Satterlund, M., Egemo Helm, K.R., Johnson, B.M., Jostad, C., Kelso, P., & Flessner, C.A. (2005). Teaching safety skills to children to prevent gun play: an evaluation of in situ training. Journal of Applied Behavior Analysis, 38(3), 395 398. Miltenberger, R.G., Roberts, J.A., Ellingson, S., Galensky, T., Rapp, J.T., Long, E.S., & Lumley, V.A. (1999) Training and generalization of sexual abuse prevention skills for women with mental retardation. Journal of Applied Behavior Analysis, 32, 385 388.

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35 Morgan, R. L., & Salzberg, C. L. (1992). Effects of video assisted training on employment related social skills of adults with severe mental retardation. Journal of Applied Behavior Analysis, 25 (2), 365 383. Newton, J. S., Olson, D., Horner, R. H., & Ard,, Jr. (1996). Social skills and the stability of social relationships between individuals with intellectu al disabilities and other community members. Research in Developmental Disabilities, 17 (1), 15 26. Nikopoulos, C. K., & Keenan, M. (2004). Effects of video modeling on social initiations by children with autism. Journal of Applied Behavior Analysis, 37 93 96. Edrishina, C. (2004). Teaching social skills to adults with intellectual disabilities: a comparison of external control and problem solving interventions. Research in Develo pmental Disabilities, 25, 399 412. Petursdottir, A. L., McComas, J., McMaster, K., & Horner, K. (2007). The effects of scripted peer tutoring and programming common stimuli on social interactions. Journal of Applied Behavior Analysis, 40 353 357. Scattone D. (2008). Social skills interventions for children with autism. Psychology in the Schools, 44 (7), 717 726. Sim, L., Whiteside, S.P., Dittner, C.A., & Mellon, M. (2006). Effectiveness of a social skills training program with school aged children: Trans ition to the clinical setting. Journal of Child and Family Studies, 15, 409 418.

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36 Stewart, G., Van Houten, R., & Van Houten, J. (1992). Increasing generalized social interactions in psychotic and mentally retarded residents through peer mediated therapy. Journal of Applied Behavior Analysis, 25(2), 335 339. Stokes, T. F., & Baer, D. M. (1977). An implicit technology of generalization. Journal of Applied Behavior Analysis, 10 349 367. Storey, K., & Gaylord Ross, R. (1987). Increasing positive social inter actions by handicapped individuals during a recreational activity using a multicomponent treatment package. Research in Developmental Disabilities, 8 627 649. Theimann, K. S., & Goldstein, H. (2001). Social stories, written text cues, and video feedback: effects on social communication of children with autism. Journal of Applied Behavior Analysis, 34 (4), 425 446. Trompenaars, F. J., Masthoff, E. D., Van Heck, G. L., De Vries, J., & Hodiamont, P. P. (2007). Relationships between social functioning and quali ty of life in a population of Dutch adult psychiatric patients. International Journal of Social Psychology, 53 (1), 36 47. Van Naarden Braun, K., Yeargin Allsopp, M., & Lollar, D. (2009). Activity limitations among young adults with developmental disabilit ies: a population based follow up study. Research in Developmental Disabilities, 30, 179 191.

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37 Whang, P. L., Fawcett, S. B., & Mathews, R. M. (1984). Teaching job related social skills to learning disabled adolescents. Analysis and Intervention in Develop mental Disabilities, 4 29 38. Wildman, B. G., Wildman, H. E., & Kelly, W. J. (1986). Group conversational skills training and social validation with mentally retarded adults. Applied Research in Mental Retardation, 7 443 458.

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38 Appendices

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39 Appendix A: DV Data Collection Sheet Client Name:_____________________ Date:_________ Time:_______ Group Home:_____________________ RA Name:__________________ indicate if the participant said each of the following statements. Please use the additional space to write down any notes that you think would be significant to the study. 1. Yes No ________________________________________________________ ___ ___________________________________________________________ ___________________________________________________________ 2. Yes No ___________________________________________________________ ______________________________________ _____________________ ___________________________________________________________ 3. Yes No ___________________________________________________________ ___________________________________________________________ _____________ ______________________________________________ 4. Yes No ___________________________________________________________ ___________________________________________________________ _________________________________________ __________________ 5. Tells staff that (RA name) is here. Yes No ___________________________________________________________ ___________________________________________________________ ___________________________________________________________

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40 Append ix B: Data sheet percentage of independence during role plays and trainings


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Evaluating behavioral skills training and in-situ training to teach greeting skills to adults with developmental disabilities
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ABSTRACT: Previous research has demonstrated that behavioral skills training (BST) is effective in teaching social skills to individuals with developmental disabilities, but often the skills fail to generalize. One strategy to promote generalization has been the use of in situ training. In an effort to improve upon previous research BST plus in situ training was evaluated to teach greeting skills to adults living in a group home setting. The percentage of correct greeting responses was evaluated in a multiple baseline across participants design. Results showed that BST was only partially effective in teaching greeting skills to the participants. However, In-situ training resulted in a greater increase in correct greeting skills across all participants.
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