Child and Family Research Outcomes from The Irish Centre for Autism and Neurodevelopmental Research

In this address, Dr. Olive Healy talks about research on child and family outcomes conducted by the Irish Centre for Autism and Neurodevelopmental Research at the National University of Ireland, Galway, where Healy is a director of research. The lecture begins with an examination of repertories, skills, and deficits in autism, and then introduces various intervention studies applied to children with autism and behavioral problems. Lastly, Healy presents research on communication repertoires and interventions in autism. This address is part of the Mollie Villeret Davis Distinguished Lecture Series, sponsored by The Meadows Center for Preventing Educational Risk at The University of Texas at Austin.Educatio

A Qualitative Investigation of a Setting-Wide PBS Workforce Development Programme in an Adult Disability Setting

The presence of distressed behaviours can amplify the difficulties experienced by people with intellectual disabilities (ID), and place pressure on the provision of effective support by organisations and direct support personnel. Setting-wide positive behaviour support (PBS) is an evidence-based framework aimed at enhancing quality of life and reducing distressed behaviour for people with intellectual disabilities through systemic change. Implementation science offers a route to better understand how we can support organisations to adopt best practice into routine procedures. This study employed a qualitative research design to examine the facilitators and barriers of a workforce development programme in setting-wide PBS in a disability service organisation through semi-structured interviews with staff (n=14). Two conceptual models of implementation science, the theoretical domain framework and the Capability, Opportunity, and Motivation (COM-B) Behaviour change model were adopted to code and analyse participant responses. Positive relationships with adults with ID, effective leadership and supervision and the systemic components of the PBS framework were highlighted as important enablers for behaviour change among participants. Workload, staff turnover, limited resources including lack of investment in workforce development and lack of mentorship were among the barriers identified. Systemic concerns with staff wellbeing, retention and capacity development continue to be prevalent in disability service provision. Outcomes indicate a need for significant investment in widespread, mandatory evidence-based training programmes in quality support for direct support staff, first line managers and service leaders

April 17, 1981

The Breeze is the student newspaper of James Madison University in Harrisonburg, Virginia

Staff Training in Intellectual and Developmental Disability Settings: a Scoping Review

© 2019, Springer Science+Business Media, LLC, part of Springer Nature. Frontline staff are a valuable asset within an intellectual and developmental disability service. Their work dictates the overall standard of care delivered by the organization. However, there is evidence that the research relating to effective practice is having little impact on the competencies displayed by staff in the real-world setting. Therefore, a scoping review of published literature was conducted to investigate potential explanations for the inadequate dissemination of evidence-based practice in this sector. Systematic searches of relevant databases identified 156 papers for inclusion in the review. Practices in which staff were trained were categorized as either behavioral interventions or “other” interventions. The behavioral category was sub-divided into: a) assessment; b) antecedent; c) consequence and, d) “mixed” practices. Although the studies reviewed provided staff training across a range of practices, many empirically supported interventions were not utilized. Despite rigorous scientific support for strategies such as functional communication training and noncontingent reinforcement, the literature did not robustly evaluate effective protocols to disseminate these practices to frontline staff. The review also highlighted a continued reliance on individualized training packages, rather than the implementation of empirically supported training models. Finally, results showed that a relatively small number of included studies examined the impact of staff training on service user outcomes and adult service users were underrepresented across all intervention categories. Findings provide a potential explanation for the apparent disconnect between theoretical advancements and practice in the applied setting and are discussed in relation to approaches to staff training

A systematic review of physiological reactivity to stimuli in autism

Objective: The prevalence of abnormal behavioural responses to a variety of stimuli among individuals with autism has led researchers to examine whether physiological reactivity is typical in this population. The current paper reviewed studies assessing physiological reactivity to sensory, social and emotional, and stressor stimuli in individuals with autism. Methods: Systematic searches of electronic databases identified 57 studies that met our inclusion criteria. A novel measure of methodological quality suitable for use with non-randomised, non-interventional, psychophysiological studies was also developed and applied. Results: Individuals with autism were found to respond differently than typically developing controls in 78.6%, 66.7%, and 71.4% of sensory, social and emotional, and stressor stimulus classes, respectively. Conclusions: Individual differences in physiological reactivity are clearly present in autism, suggesting additional research is needed to determine the variables relating to physiological reactivity among those with ASD and to examine the possibility of physiological subtype responders in this population

Labels and descriptions of dental behaviour support techniques: A scoping review of clinical practice guidelines

Introduction: There is no agreed taxonomy of the techniques used to support patients to receive professional oral healthcare. This lack of specification leads to imprecision in describing, understanding, teaching and implementing behaviour support techniques in dentistry (DBS). Methods: This review aims to identify the labels and associated descriptors used by practitioners to describe DBS techniques, as a first step in developing a shared terminology for DBS techniques. Following registration of a protocol, a scoping review limited to Clinical Practice Guidelines only was undertaken to identify the labels and descriptors used to refer to DBS techniques. Results: From 5317 screened records, 30 were included, generating a list of 51 distinct DBS techniques. General anaesthesia was the most commonly reported DBS (n = 21). This review also explores what term is given to DBS techniques as a group (Behaviour management was most commonly used (n = 8)) and how these techniques were categorized (mainly distinguishing between pharmacological and non‐pharmacological). Conclusions: This is the first attempt to generate a list of techniques that can be selected for patients and marks an initial step in future efforts at agreeing and categorizing these techniques into an accepted taxonomy, with all the benefits this brings to research, education, practice and patients

Behaviour support in dentistry: A Delphi study to agree terminology in behaviour management

Objectives: Dental behaviour support (DBS) describes all specific techniques practiced to support patients in their experience of professional oral healthcare. DBS is roughly synonymous with behaviour management, which is an outdated concept. There is no agreed terminology to specify the techniques used to support patients who receive dental care. This lack of specificity may lead to imprecision in describing, understanding, teaching, evaluating and implementing behaviour support techniques in dentistry. Therefore, this e-Delphi study aimed to develop a list of agreed labels and descriptions of DBS techniques used in dentistry and sort them according to underlying principles of behaviour. // Methods: Following a registered protocol, a modified e-Delphi study was applied over two rounds with a final consensus meeting. The threshold of consensus was set a priori at 75%. Agreed techniques were then categorized by four coders, according to behavioural learning theory, to sort techniques according to their mechanism of action. // Results: The panel (n = 35) agreed on 42 DBS techniques from a total of 63 candidate labels and descriptions. Complete agreement was achieved regarding all labels and descriptions, while agreement was not achieved regarding distinctiveness for 17 techniques. In exploring underlying principles of learning, it became clear that multiple and differing principles may apply depending on the specific context and procedure in which the technique may be applied. // Discussion: Experts agreed on what each DBS technique is, what label to use, and their description, but were less likely to agree on what distinguishes one technique from another. All techniques were describable but not comprehensively categorizable according to principles of learning. While objective consistency was not attained, greater clarity and consistency now exists. The resulting list of agreed terminology marks a significant foundation for future efforts towards understanding DBS techniques in research, education and clinical care

Behaviour support in dentistry: A Delphi study to agree terminology in behaviour management

Objectives: Dental behaviour support (DBS) describes all specific techniques practiced to support patients in their experience of professional oral healthcare. DBS is roughly synonymous with behaviour management, which is an outdated concept. There is no agreed terminology to specify the techniques used to support patients who receive dental care. This lack of specificity may lead to imprecision in describing, understanding, teaching, evaluating and implementing behaviour support techniques in dentistry. Therefore, this e‐Delphi study aimed to develop a list of agreed labels and descriptions of DBS techniques used in dentistry and sort them according to underlying principles of behaviour. Methods: Following a registered protocol, a modified e‐Delphi study was applied over two rounds with a final consensus meeting. The threshold of consensus was set a priori at 75%. Agreed techniques were then categorized by four coders, according to behavioural learning theory, to sort techniques according to their mechanism of action. Results: The panel (n = 35) agreed on 42 DBS techniques from a total of 63 candidate labels and descriptions. Complete agreement was achieved regarding all labels and descriptions, while agreement was not achieved regarding distinctiveness for 17 techniques. In exploring underlying principles of learning, it became clear that multiple and differing principles may apply depending on the specific context and procedure in which the technique may be applied. Discussion: Experts agreed on what each DBS technique is, what label to use, and their description, but were less likely to agree on what distinguishes one technique from another. All techniques were describable but not comprehensively categorizable according to principles of learning. While objective consistency was not attained, greater clarity and consistency now exists. The resulting list of agreed terminology marks a significant foundation for future efforts towards understanding DBS techniques in research, education and clinical care