Education and Training in Developmental Disabilities - Division on ...
Education and Training in Developmental Disabilities - Division on ...
Education and Training in Developmental Disabilities - Division on ...
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(i.e., before the <str<strong>on</strong>g>in</str<strong>on</strong>g>troducti<strong>on</strong> of C<strong>on</strong>diti<strong>on</strong><br />
BC), the PI, Co-<str<strong>on</strong>g>in</str<strong>on</strong>g>vestigator, <str<strong>on</strong>g>and</str<strong>on</strong>g> graduate<br />
students reviewed tra<str<strong>on</strong>g>in</str<strong>on</strong>g><str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>in</str<strong>on</strong>g> adm<str<strong>on</strong>g>in</str<strong>on</strong>g>istrati<strong>on</strong><br />
of the dysphagia treatment program <str<strong>on</strong>g>and</str<strong>on</strong>g> the<br />
PRBMP at the school site for school pers<strong>on</strong>nel<br />
with the same methods, h<str<strong>on</strong>g>and</str<strong>on</strong>g>outs, <str<strong>on</strong>g>and</str<strong>on</strong>g> read<str<strong>on</strong>g>in</str<strong>on</strong>g>gs<br />
as presented dur<str<strong>on</strong>g>in</str<strong>on</strong>g>g the previous tra<str<strong>on</strong>g>in</str<strong>on</strong>g><str<strong>on</strong>g>in</str<strong>on</strong>g>g<br />
sessi<strong>on</strong>s. School staff members were also given<br />
a written packet c<strong>on</strong>ta<str<strong>on</strong>g>in</str<strong>on</strong>g><str<strong>on</strong>g>in</str<strong>on</strong>g>g the pre-sessi<strong>on</strong><br />
preference assessment materials, the OMSP,<br />
<str<strong>on</strong>g>and</str<strong>on</strong>g> daily activities <str<strong>on</strong>g>and</str<strong>on</strong>g> materials for oral-motor<br />
exercises. The BC c<strong>on</strong>diti<strong>on</strong> occurred for<br />
a 3-week time period. Guidance <str<strong>on</strong>g>and</str<strong>on</strong>g> <str<strong>on</strong>g>in</str<strong>on</strong>g>structi<strong>on</strong><br />
by the PI, Co-PI, <str<strong>on</strong>g>and</str<strong>on</strong>g> graduate students<br />
were systematically faded as the classroom pers<strong>on</strong>nel<br />
exhibited skill <str<strong>on</strong>g>in</str<strong>on</strong>g> specialized feed<str<strong>on</strong>g>in</str<strong>on</strong>g>g<br />
<str<strong>on</strong>g>and</str<strong>on</strong>g> behavior management techniques. By the<br />
start of the third week of c<strong>on</strong>diti<strong>on</strong> BC, the<br />
school staff provided 100% of the <str<strong>on</strong>g>in</str<strong>on</strong>g>terventi<strong>on</strong>s.<br />
To counterbalance <str<strong>on</strong>g>in</str<strong>on</strong>g>terventi<strong>on</strong>s, Group 1<br />
followed an A-BC-B-C-BC2-BC c<strong>on</strong>diti<strong>on</strong><br />
sequence, Group 2 followed an A-B-BC-C-<br />
BC2-BC sequence, <str<strong>on</strong>g>and</str<strong>on</strong>g> Group 3 followed an<br />
A-C-BC-B-BC2-BC sequence. Individual performance<br />
data were collected dur<str<strong>on</strong>g>in</str<strong>on</strong>g>g each sessi<strong>on</strong>.<br />
Additi<strong>on</strong>al graduate students c<strong>on</strong>ducted<br />
<str<strong>on</strong>g>in</str<strong>on</strong>g>dependent analysis of at least 20% of all<br />
sessi<strong>on</strong>s to calculate performance <str<strong>on</strong>g>and</str<strong>on</strong>g> procedural<br />
reliability (Bill<str<strong>on</strong>g>in</str<strong>on</strong>g>gsley, White, & Muns<strong>on</strong>,<br />
1980; Tawney & Gast, 1984).<br />
Trend <str<strong>on</strong>g>and</str<strong>on</strong>g> Level Analysis<br />
Frequency data for target skills <str<strong>on</strong>g>and</str<strong>on</strong>g> behaviors<br />
dur<str<strong>on</strong>g>in</str<strong>on</strong>g>g each phase of treatment were<br />
c<strong>on</strong>verted <str<strong>on</strong>g>in</str<strong>on</strong>g>to percentages of accurate resp<strong>on</strong>ses.<br />
Changes <str<strong>on</strong>g>in</str<strong>on</strong>g> levels <str<strong>on</strong>g>and</str<strong>on</strong>g> trends were<br />
analyzed accord<str<strong>on</strong>g>in</str<strong>on</strong>g>g to percentages of dependent<br />
<str<strong>on</strong>g>and</str<strong>on</strong>g> <str<strong>on</strong>g>in</str<strong>on</strong>g>dependent variables. Kazd<str<strong>on</strong>g>in</str<strong>on</strong>g>’s<br />
(1982) <str<strong>on</strong>g>and</str<strong>on</strong>g> Tawney <str<strong>on</strong>g>and</str<strong>on</strong>g> Gast’s (1984) techniques<br />
for calculati<strong>on</strong> <str<strong>on</strong>g>and</str<strong>on</strong>g> statistical analysis<br />
for s<str<strong>on</strong>g>in</str<strong>on</strong>g>gle-subject experimental design were<br />
employed.<br />
Reliability <str<strong>on</strong>g>and</str<strong>on</strong>g> Validity<br />
To establish reliability, an <str<strong>on</strong>g>in</str<strong>on</strong>g>dependent licensed<br />
SLP observed <str<strong>on</strong>g>and</str<strong>on</strong>g> rated videotaped<br />
records of all evaluati<strong>on</strong>s. To ensure reliability<br />
<str<strong>on</strong>g>in</str<strong>on</strong>g> provisi<strong>on</strong> of <str<strong>on</strong>g>in</str<strong>on</strong>g>terventi<strong>on</strong>s, programs were<br />
implemented by the same feeders/cl<str<strong>on</strong>g>in</str<strong>on</strong>g>icians<br />
over the course of the <str<strong>on</strong>g>in</str<strong>on</strong>g>vestigati<strong>on</strong>. The PI<br />
<str<strong>on</strong>g>and</str<strong>on</strong>g> two additi<strong>on</strong>al licensed SLPs supervised<br />
<strong>on</strong>-site 4 days per week. The Co-PI was present<br />
dur<str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>in</str<strong>on</strong>g>itial weeks of the project <str<strong>on</strong>g>and</str<strong>on</strong>g> provided<br />
<strong>on</strong>-site support <str<strong>on</strong>g>in</str<strong>on</strong>g>termittently dur<str<strong>on</strong>g>in</str<strong>on</strong>g>g<br />
the study <str<strong>on</strong>g>and</str<strong>on</strong>g> c<strong>on</strong>sistently dur<str<strong>on</strong>g>in</str<strong>on</strong>g>g the BC<br />
phase. Interrater <str<strong>on</strong>g>and</str<strong>on</strong>g> procedural reliability<br />
measures were completed for 20% of all <str<strong>on</strong>g>in</str<strong>on</strong>g>terventi<strong>on</strong><br />
sessi<strong>on</strong>s.<br />
To c<strong>on</strong>trol for extraneous variables, the PI<br />
<str<strong>on</strong>g>and</str<strong>on</strong>g> Co-PI provided all tra<str<strong>on</strong>g>in</str<strong>on</strong>g><str<strong>on</strong>g>in</str<strong>on</strong>g>g us<str<strong>on</strong>g>in</str<strong>on</strong>g>g the same<br />
materials, methods, <str<strong>on</strong>g>and</str<strong>on</strong>g> h<str<strong>on</strong>g>and</str<strong>on</strong>g>outs for all graduate<br />
students <str<strong>on</strong>g>and</str<strong>on</strong>g> school staff members. All<br />
<str<strong>on</strong>g>in</str<strong>on</strong>g>terventi<strong>on</strong>s were adm<str<strong>on</strong>g>in</str<strong>on</strong>g>istered under direct<br />
supervisi<strong>on</strong> of the research team. This helped<br />
to ensure procedural reliability across <str<strong>on</strong>g>in</str<strong>on</strong>g>terventi<strong>on</strong>ists.<br />
The brief withdrawal c<strong>on</strong>diti<strong>on</strong>s<br />
also helped to isolate the <str<strong>on</strong>g>in</str<strong>on</strong>g>terventi<strong>on</strong>(s) that<br />
produced the greatest effect.<br />
To attempt to show generalizability <str<strong>on</strong>g>in</str<strong>on</strong>g> this<br />
<str<strong>on</strong>g>in</str<strong>on</strong>g>vestigati<strong>on</strong>, two different graduate students<br />
provided <str<strong>on</strong>g>in</str<strong>on</strong>g>terventi<strong>on</strong>s for the first 11 weeks of<br />
the study <str<strong>on</strong>g>and</str<strong>on</strong>g> the school staff provided all<br />
<str<strong>on</strong>g>in</str<strong>on</strong>g>terventi<strong>on</strong>s for the last three weeks. Data<br />
were collected <str<strong>on</strong>g>in</str<strong>on</strong>g> the same manner by the<br />
same graduate students dur<str<strong>on</strong>g>in</str<strong>on</strong>g>g the entire 14week<br />
study period as a way of dem<strong>on</strong>strat<str<strong>on</strong>g>in</str<strong>on</strong>g>g<br />
<str<strong>on</strong>g>in</str<strong>on</strong>g>terventi<strong>on</strong> effects across <str<strong>on</strong>g>in</str<strong>on</strong>g>terventi<strong>on</strong>ists<br />
<str<strong>on</strong>g>and</str<strong>on</strong>g> participants.<br />
Results<br />
Figures 1, 2, <str<strong>on</strong>g>and</str<strong>on</strong>g> 3 present <str<strong>on</strong>g>in</str<strong>on</strong>g>dividual participant<br />
data for three selected participants (<strong>on</strong>e<br />
participant from each group) relative to <str<strong>on</strong>g>in</str<strong>on</strong>g>dividual<br />
goals. Tables 2 <str<strong>on</strong>g>and</str<strong>on</strong>g> 3 present group <str<strong>on</strong>g>and</str<strong>on</strong>g><br />
<str<strong>on</strong>g>in</str<strong>on</strong>g>dividual data relative to feed<str<strong>on</strong>g>in</str<strong>on</strong>g>g skill <str<strong>on</strong>g>and</str<strong>on</strong>g><br />
positive mealtime behavior goals. Comparis<strong>on</strong><br />
of participants’ performances dur<str<strong>on</strong>g>in</str<strong>on</strong>g>g study<br />
c<strong>on</strong>diti<strong>on</strong>s provides clear evidence of effectiveness<br />
of the <str<strong>on</strong>g>in</str<strong>on</strong>g>terventi<strong>on</strong>s.<br />
Group Trends - Feed<str<strong>on</strong>g>in</str<strong>on</strong>g>g Skill <str<strong>on</strong>g>and</str<strong>on</strong>g> Positive<br />
Mealtime Behavior Goals<br />
Group results were compared across all feed<str<strong>on</strong>g>in</str<strong>on</strong>g>g<br />
skill goals to assess trends <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>in</str<strong>on</strong>g>terventi<strong>on</strong><br />
results (see Table 2). For all participants, therapeutic<br />
ga<str<strong>on</strong>g>in</str<strong>on</strong>g>s were made <str<strong>on</strong>g>in</str<strong>on</strong>g> feed<str<strong>on</strong>g>in</str<strong>on</strong>g>g skills from<br />
the basel<str<strong>on</strong>g>in</str<strong>on</strong>g>e c<strong>on</strong>diti<strong>on</strong> (A) through the comb<str<strong>on</strong>g>in</str<strong>on</strong>g>ed<br />
<str<strong>on</strong>g>in</str<strong>on</strong>g>terventi<strong>on</strong> c<strong>on</strong>diti<strong>on</strong> with staff provid<str<strong>on</strong>g>in</str<strong>on</strong>g>g<br />
<str<strong>on</strong>g>in</str<strong>on</strong>g>terventi<strong>on</strong>s (BC). Visual <str<strong>on</strong>g>in</str<strong>on</strong>g>specti<strong>on</strong> of<br />
data revealed that greater ga<str<strong>on</strong>g>in</str<strong>on</strong>g>s were made <str<strong>on</strong>g>in</str<strong>on</strong>g><br />
feed<str<strong>on</strong>g>in</str<strong>on</strong>g>g skills <str<strong>on</strong>g>in</str<strong>on</strong>g> the comb<str<strong>on</strong>g>in</str<strong>on</strong>g>ed (BC) treatment<br />
c<strong>on</strong>diti<strong>on</strong> than <str<strong>on</strong>g>in</str<strong>on</strong>g> the other c<strong>on</strong>diti<strong>on</strong>s for<br />
Groups 1 <str<strong>on</strong>g>and</str<strong>on</strong>g> 2. Group 3 made greater ga<str<strong>on</strong>g>in</str<strong>on</strong>g>s<br />
Feed<str<strong>on</strong>g>in</str<strong>on</strong>g>g Skills <str<strong>on</strong>g>and</str<strong>on</strong>g> Mealtime Behaviors / 87