Education and Training in Developmental Disabilities - Division on ...

(i.e., before the <strong>in</strong>troduction of Condition
BC), the PI, Co-<strong>in</strong>vestigator, <strong>and</strong> graduate
students reviewed tra<strong>in</strong><strong>in</strong>g <strong>in</strong> adm<strong>in</strong>istration
of the dysphagia treatment program <strong>and</strong> the
PRBMP at the school site for school personnel
with the same methods, h<strong>and</strong>outs, <strong>and</strong> read<strong>in</strong>gs
as presented dur<strong>in</strong>g the previous tra<strong>in</strong><strong>in</strong>g
sessions. School staff members were also given
a written packet conta<strong>in</strong><strong>in</strong>g the pre-session
preference assessment materials, the OMSP,
<strong>and</strong> daily activities <strong>and</strong> materials for oral-motor
exercises. The BC condition occurred for
a 3-week time period. Guidance <strong>and</strong> <strong>in</strong>struction
by the PI, Co-PI, <strong>and</strong> graduate students
were systematically faded as the classroom personnel
exhibited skill <strong>in</strong> specialized feed<strong>in</strong>g
<strong>and</strong> behavior management techniques. By the
start of the third week of condition BC, the
school staff provided 100% of the <strong>in</strong>terventions.
To counterbalance <strong>in</strong>terventions, Group 1
followed an A-BC-B-C-BC2-BC condition
sequence, Group 2 followed an A-B-BC-C-
BC2-BC sequence, <strong>and</strong> Group 3 followed an
A-C-BC-B-BC2-BC sequence. Individual performance
data were collected dur<strong>in</strong>g each session.
Additional graduate students conducted
<strong>in</strong>dependent analysis of at least 20% of all
sessions to calculate performance <strong>and</strong> procedural
reliability (Bill<strong>in</strong>gsley, White, & Munson,
1980; Tawney & Gast, 1984).
Trend <strong>and</strong> Level Analysis
Frequency data for target skills <strong>and</strong> behaviors
dur<strong>in</strong>g each phase of treatment were
converted <strong>in</strong>to percentages of accurate responses.
Changes <strong>in</strong> levels <strong>and</strong> trends were
analyzed accord<strong>in</strong>g to percentages of dependent
<strong>and</strong> <strong>in</strong>dependent variables. Kazd<strong>in</strong>’s
(1982) <strong>and</strong> Tawney <strong>and</strong> Gast’s (1984) techniques
for calculation <strong>and</strong> statistical analysis
for s<strong>in</strong>gle-subject experimental design were
employed.
Reliability <strong>and</strong> Validity
To establish reliability, an <strong>in</strong>dependent licensed
SLP observed <strong>and</strong> rated videotaped
records of all evaluations. To ensure reliability
<strong>in</strong> provision of <strong>in</strong>terventions, programs were
implemented by the same feeders/cl<strong>in</strong>icians
over the course of the <strong>in</strong>vestigation. The PI
<strong>and</strong> two additional licensed SLPs supervised
on-site 4 days per week. The Co-PI was present
dur<strong>in</strong>g <strong>in</strong>itial weeks of the project <strong>and</strong> provided
on-site support <strong>in</strong>termittently dur<strong>in</strong>g
the study <strong>and</strong> consistently dur<strong>in</strong>g the BC
phase. Interrater <strong>and</strong> procedural reliability
measures were completed for 20% of all <strong>in</strong>tervention
sessions.
To control for extraneous variables, the PI
<strong>and</strong> Co-PI provided all tra<strong>in</strong><strong>in</strong>g us<strong>in</strong>g the same
materials, methods, <strong>and</strong> h<strong>and</strong>outs for all graduate
students <strong>and</strong> school staff members. All
<strong>in</strong>terventions were adm<strong>in</strong>istered under direct
supervision of the research team. This helped
to ensure procedural reliability across <strong>in</strong>terventionists.
The brief withdrawal conditions
also helped to isolate the <strong>in</strong>tervention(s) that
produced the greatest effect.
To attempt to show generalizability <strong>in</strong> this
<strong>in</strong>vestigation, two different graduate students
provided <strong>in</strong>terventions for the first 11 weeks of
the study <strong>and</strong> the school staff provided all
<strong>in</strong>terventions for the last three weeks. Data
were collected <strong>in</strong> the same manner by the
same graduate students dur<strong>in</strong>g the entire 14week
study period as a way of demonstrat<strong>in</strong>g
<strong>in</strong>tervention effects across <strong>in</strong>terventionists
<strong>and</strong> participants.
Results
Figures 1, 2, <strong>and</strong> 3 present <strong>in</strong>dividual participant
data for three selected participants (one
participant from each group) relative to <strong>in</strong>dividual
goals. Tables 2 <strong>and</strong> 3 present group <strong>and</strong>
<strong>in</strong>dividual data relative to feed<strong>in</strong>g skill <strong>and</strong>
positive mealtime behavior goals. Comparison
of participants’ performances dur<strong>in</strong>g study
conditions provides clear evidence of effectiveness
of the <strong>in</strong>terventions.
Group Trends - Feed<strong>in</strong>g Skill <strong>and</strong> Positive
Mealtime Behavior Goals
Group results were compared across all feed<strong>in</strong>g
skill goals to assess trends <strong>in</strong> <strong>in</strong>tervention
results (see Table 2). For all participants, therapeutic
ga<strong>in</strong>s were made <strong>in</strong> feed<strong>in</strong>g skills from
the basel<strong>in</strong>e condition (A) through the comb<strong>in</strong>ed
<strong>in</strong>tervention condition with staff provid<strong>in</strong>g
<strong>in</strong>terventions (BC). Visual <strong>in</strong>spection of
data revealed that greater ga<strong>in</strong>s were made <strong>in</strong>
feed<strong>in</strong>g skills <strong>in</strong> the comb<strong>in</strong>ed (BC) treatment
condition than <strong>in</strong> the other conditions for
Groups 1 <strong>and</strong> 2. Group 3 made greater ga<strong>in</strong>s
Feed<strong>in</strong>g Skills <strong>and</strong> Mealtime Behaviors / 87