University of Nebraska Medical Centers MunroeMeyer Institute Center for Autism Spectrum Disorders Coauthors Wayne W Fisher Andrew Blowers Stephanie A Hood Aaron D Lesser Mychal A ID: 707136
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Kevin C. Luczynski, Ph.D., BCBA-D
University of Nebraska Medical Center’s Munroe-Meyer InstituteCenter for Autism Spectrum DisordersCo-authors: Wayne W. Fisher, Andrew Blowers, Stephanie A. Hood, Aaron D. Lesser, Mychal A. Machado, Maegan Pisman, & Megan E. VostersFunding Source: Grant Number AR100184 from the Autism Research Program, which is a component of the Congressionally Directed Medical Research Programs within the Department of Defense
Preliminary Findings in a
Randomized Clinical Trial of a
Virtual Training Program for
Parents
of
a Child with AutismSlide2
Wayne Fisher, Ph.D.
Kevin Luczynski, Ph.D.Stephanie Hood, Ph.D.
Maegan Pisman, M.S.
Aaron Lesser,
Ph.D.
Andrew Blowers, M.S.
Megan Vosters, M.S.
Mychal Machado
Ph.D.
Cathleen Piazza,
Ph.D.Slide3Slide4Slide5Slide6Slide7Slide8Slide9
Dr. Deb Roy Slide10Slide11
Wireless
Video CameraHigh-Definition WebcamBluetooth EarpieceLaptopSlide12
The desired intensity of EIBI services is high
Dose of EIBI > 25 hrSlide13
Limited number of credentialed
therapists relative to the need
The desired intensity of EIBI services is high
Dose of EIBI
>
25
hrSlide14
Incorporate Parents in Treatment
ServicesSlide15
Fiber Optic Network
Clinic Near ParentIn-clinic Trained Assistants
Clinic to
ClinicSlide16Slide17
Fiber Optic Network
Clinic Near ParentIn-clinic Trained Assistants
Virtual Private Network
Parent’s Home
Only Remote Coaching
Clinic to
Clinic
Clinic to
Home
Form1Slide18Slide19
Fiber Optic Network
Clinic Near ParentIn-clinic Trained Assistants
Virtual Private Network
Parent’s Home
Only Remote Coaching
Clinic to
Clinic
Clinic to
Home
Form 1
Virtual
Private Network
Parent’s
Home
In-home Naive
A
ssistants
Clinic to
Home
Form 2Slide20
Method
included a…Randomized-clinical trialVirtual-training program with a variety of EIBI proceduresExtended studies on virtual training programs by… Evaluating the effects of the training using competency measures verified via direct observationResults indicated … Technicians implemented a variety of behavioral protocols with high procedural integritySlide21
Inclusion Criteria
At least 19 years of ageChild that met diagnostic criteria for ASDNo prior training in ABANo prior coursework in behavior analysisNo ongoing EIBI servicesInternet connection in the homeSlide22
Parent-Training Evaluation
P 1
P 2Slide23
Parent-Training Evaluation
P 1Pre-Tests
P 2Slide24
Wireless
Video CameraHigh-Definition WebcamBluetooth EarpieceTeachingStimuliLaptopSlide25
Parent
’s HomeSlide26
Parent
’s HomeSlide27
Research in Clinic
Expert in Clinic
Synchronous
Instruction
(
encrypted
connection)
Parent
’
s HomeSlide28
Research in Clinic
Expert in Clinic
(
encrypted
connection)
Synchronous
Instruction
Parent
’
s HomeSlide29
Parent-Training Evaluation
P 1Pre-Tests
P 2
Behavioral Implementation of Skills for
Work
Activities
Touch DogSlide30
Trial 1
Trial 2
Trial 3
Trial 4
Trial 5
Trial 6
Trial 7
Trial 8
Trial 9
Trial 10
Trial 11
Trial 12
Trial 13
Trial 14
Trial 15
Trial 16
Trial 17
Trial 18
Trial 19
Trial 20
Behavioral Implementation Skills for
Work
ActivitiesSlide31
Trial 1
Trial 2
Trial 3
Trial 4
Trial 5
Trial 6
Trial 7
Trial 8
Trial 9
Trial 10
Trial 11
Trial 12
Trial 13
Trial 14
Trial 15
Trial 16
Trial 17
Trial 18
Trial 19
Trial 20
Correct Response
Behavioral Implementation Skills for
Work
ActivitiesSlide32
Trial 1
Trial 2
Trial 3
Trial 4
Trial 5
Trial 6
Trial 7
Trial 8
Trial 9
Trial 10
Trial 11
Trial 12
Trial 13
Trial 14
Trial 15
Trial 16
Trial 17
Trial 18
Trial 19
Trial 20
Correct Response
No Response
Incorrect Response
Behavioral Implementation Skills for
Work
ActivitiesSlide33
Trial 1
Trial 2
Trial 3
Trial 4
Trial 5
Trial 6
Trial 7
Trial 8
Trial 9
Trial 10
Trial 11
Trial 12
Trial 13
Trial 14
Trial 15
Trial 16
Trial 17
Trial 18
Trial 19
Trial 20
Correct Response
No Response
Incorrect Response
Problem Behavior
Aggression
Echolalia
Neg. Vocalization
Stereotypy
Aggression
Stereotypy
Disruption
Disruption
Neg. Vocalization
Echolalia
Behavioral Implementation Skills for
Work
ActivitiesSlide34Slide35Slide36Slide37Slide38
Parent-Training Evaluation
P 1Pre-Tests
P 2
Behavioral Implementation of Skills for
Work
Activities
Behavioral Implementation of Skills for
Play
Activities Slide39
Trial 1
Trial 2
Trial 3
Trial 4
Trial 5
Trial 6
Trial 7
Trial 8
Trial 9
Trial 10
Trial 11
Trial 12
Trial 13
Trial 14
Trial 15
Trial 16
Trail 17
Trail 18
Trial 19
Trial 20
Joint Attention
Functional
Play
Describes Emotions
Initiates
Play
Aggression
Stereotypy
Disruption
Neg. Vocalization
Echolalia
Aggression
Stereotypy
Disruption
Echolalia
Neg. Vocalization
Problem Behavior
Behavioral Implementation Skills for
Play
Activities
Initiates
ConversationSlide40Slide41
P 1
Pre-Tests
Group
Assignment
(randomization)
P 2
Parent-Training Evaluation
Matched Control
TestSlide42
P 1
Pre-Tests
Group
Assignment
(randomization)
Technology – Enhanced Training
P 2
Parent-Training Evaluation
Matched Control
TestSlide43
3
Module Number124
5
6
7
8
Parent
-Training EvaluationSlide44
3
Module Number124
5
6
7
8
Parent
-Training EvaluationSlide45
3
Module Number124
5
6
Verbal
Behavior
Ethics & Vulnerable Pop.
Nat. Environmental
Tx’g
Compliance
Preventing
Problem
Bx
Putting it Together I
Putting it Together
II
Response Prompting
7
8
Parent
-Training EvaluationSlide46
3
Module Number124
5
6
Verbal
Behavior
Ethics & Vulnerable Pop.
Nat. Environmental
Tx’g
Compliance
Preventing
Problem
Bx
Putting it Together I
Putting it Together
II
Response Prompting
7
8
Parent
-Training EvaluationSlide47Slide48
Parent
’s Home
Research in Clinic
Expert in Clinic
Synchronous
Instruction &
Feedback
(
encrypted
connection)Slide49
P 1
Pre-Tests
Group
Assignment
(randomization)
Technology – Enhanced Training
Post-Test
P 2
Parent-Training Evaluation
Matched Control
TestSlide50Slide51Slide52Slide53
Parent’s Satisfaction with …
Web-Based TechnologySlide54
Parent’s Satisfaction with …
Web-Based TechnologyReliability of Audio & Video during Role-PlaysBlackboard to Deliver e-Learning Modules and Quizzes
Accessing Virtual Meeting and Initiating Audio and VideoSlide55
Reliability of Audio & Video during Role-Plays
Blackboard to Deliver e-Learning Modules and QuizzesParent’s Satisfaction with …
Web-Based Technology
Accessing Virtual Meeting and Initiating Audio and VideoSlide56
Reliability of Audio & Video during Role-Plays
Blackboard to Deliver e-Learning Modules and Quizzes
Parent’s Satisfaction with …
Web-Based Technology
Accessing Virtual Meeting and Initiating Audio and Video
“Without
question, dealing with Blackboard's poor design was the worst part of the training program
.”Slide57
Amount and Type of Content in e-Learning Modules
Role-Plays as a Training ComponentDesign Quality & Organization of ModulesThe Amount I Learned
Parent’s Satisfaction with …
E-Learning Content in ModulesSlide58
Consultant’s Ability to Answer Questions
Communications with ConsultantConsultant (BCBA)
Parent’s Satisfaction with …Slide59
Completing the Program at Preferred Pace
Flexibility of Meeting and Role-playsParent’s Satisfaction with …
Scheduling Slide60
The Overall Training ProgramSlide61
One of the first RCTs using web-based training of parents that includes competency measures
No traveling, which saves time and moneyTraining can be provided anywhere, given sufficient internet accessThis method of training could be adapted for other skill areasConclusion and Implications . . . Slide62
Cross-continent evaluation of the virtual training program with parents, and include a stimulus generalization assessment with the parent’s child.
Future Directions . . . Slide63Slide64
Cross-continent evaluation of the virtual training program with parents, and include a stimulus generalization assessment with the parent’s child.
Train-the-trainer evaluation via a pyramidal model. Are the in-home scripted role-plays necessary to the effectiveness and social validity?Future Directions . . .