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Prior research has evaluated the reliability and validity of structured visual inspection (SVI) criteria for interpreting functional analysis (FA) outcomes (Hagopian et al., 1997; Roane et al., 2013). We adapted these criteria to meet the unique needs of interpreting latency-based FA outcomes and examined the reliability and validity of applying SVI criteria to 43 previously published latency-based FA datasets. Overall, raters agreed on SVI-determined FA outcomes (98% of functions and 95% of cases) and these outcomes corresponded well to the interpretations provided by the authors of these 43 datasets (94% of functions and 88% of cases), indicating a high degree of reliability and concurrent validity. Our findings suggest that the use of SVI criteria may (a) serve as an objective aid in the identification of behavioral function(s), (b) produce high levels of agreement among expert raters, and (c) serve as a useful resource when teaching students how to interpret latency-based FA outcomes.

BackgroundThe Affordable Care Act and the introduction of accountable care organizations (ACOs) have increased the incentives for patients and providers to engage in preventive care, for example, through quality metrics linked to disease prevention. However, little is known about how ACOs deliver preventive care services.ObjectiveTo understand how Medicare ACOs provide preventive care services to their attributed patients.DesignMixed-methods study using survey data reporting Medicare ACO capabilities in patient care management and interviews with high-performing ACOs.ParticipantsACO executives completed survey data on 283 Medicare ACOs. These data were supplemented with 39 interviews conducted across 18 Medicare ACOs with executive-level leaders and associated clinical and managerial staff.Main measuresSurvey measures included ACO performance, organizational characteristics, collaboration experience, and capabilities in care management and quality improvement. Telephone interviews followed a semi-structured interview guide and explored the mechanisms used, and motivations of, ACOs to deliver preventive care services.Key resultsMedicare ACOs that reported being comprehensively engaged in the planning and management of patient care - including conducting reminders for preventive care services - had more beneficiaries and had a history of collaboration experience, but were not more likely to receive shared savings or achieve high-quality scores compared to other surveyed ACOs. Interviews revealed that offering annual wellness visits and having a system-wide approach to closing preventive care gaps are key mechanisms used by high-performing ACOs to address patients' preventive care needs. Few programs or initiatives were identified that specifically target clinically complex patients. Aside from meeting patient needs, motivations for ACOs included increasing patient attribution and meeting performance targets.ConclusionsACOs are increasingly motivated to deliver preventive care services. Understanding the mechanisms and motivations used by high-performing ACOs may help both providers and payers to increase the use of preventive care.

It is unknown whether and to what extent common types of attention delivered in early childhood environments are preferred by and function as reinforcers for young children. We assessed children's preference for commonly delivered types of attention across 31 preschool-aged participants (Experiment 1). Next, we conducted a reinforcer assessment (Experiment 2) and a progressive-ratio assessment (Experiment 3) to: (1) validate the results of the preference assessment; and (2) determine the relative reinforcing efficacy of each type of attention. Results of Experiment 1 showed that most participants preferred conversation or physical interaction. Results of Experiment 2 validated the results of Experiment 1 showing preferred types of attention were more likely to function as reinforcers. Finally, although some types of attention functioned as reinforcers, results of Experiment 3 indicated these reinforcers only maintained responding under relatively dense schedules of reinforcement. Clinical implications and directions for future research are discussed.

Author(s): Nina T. Rogers, David Pell, Tarra L. Penney, Oliver Mytton, Adam Briggs, Steven Cummins, Mike Rayner, Harry Rutter, Peter Scarborough, Stephen J. Sharp, Richard D. Smith, Martin White, Jean [...]

Objectives: Despite significant investment in social prescribing in England over the last decade, we still do not know if it works, or how models of social prescribing fit within wider health and care policy and practice. This study explores current service delivery structures and assesses the feasibility of a national evaluation of the link worker model. Methods: Semi-structured interviews were conducted between May and September 2020, with 25 key informants from across social prescribing services in England. Participants included link workers, voluntary, community and social enterprise staff, and those involved in policy and decision-making for social prescribing services. Interview and workshop transcripts were analysed thematically, adopting a framework approach. Results: We found differences in how services are provided, including by individual link workers, and between organisations and regions. Standards, referral pathways, reporting, and monitoring structures differ or are lacking in voluntary services as compared to clinical services. People can self-refer to a link worker or be referred by a third party, but the lack of standardised processes generated confusion in both public and professional perceptions of the link worker model. We identified challenges in determining the appropriate outcomes and outcome measures needed to assess the impact of the link worker model. Conclusions: The current varied service delivery structures in England poses major challenges for a national impact evaluation. Any future rigorous evaluation needs to be underpinned with national standardised outcomes and process measures which promote uniform data collection. [ABSTRACT FROM AUTHOR]

Elopement occurs when an individual runs away from or leaves a supervised area. Elopement is a dangerous behavior that requires diligence from school personnel in order to effectively reduce its occurrence. Using a step-by-step process to identify the reasons goal-directed elopement occurs and then implementing an intervention to effectively teach more appropriate ways to access those reinforcers can accomplish this.

Functional communication training is a well-established treatment for socially reinforced destructive behavior that typically includes differential reinforcement of the functional communication response (FCR) in combination with extinction of destructive behavior. However, when the schedule of reinforcement for the FCR is thinned, destructive behavior may resurge (e.g., Greer, Fisher, Saini, Owen, & Jones, 2016). Currently, data are unavailable on the prevalence and characteristics of resurgence during reinforcement schedule thinning. In this study, we evaluated the prevalence of resurgence during reinforcement schedule thinning on a per-case and per-schedule-step basis and also evaluated the magnitude of resurgence in relation to the functions of destructive behavior. We observed resurgence in 19 of the 25 (76%) applications of reinforcement schedule thinning. In some cases, the magnitude of resurgence exceeded the mean levels of destructive behavior observed in baseline. We discuss these results relative to prior translational and applied research on resurgence.

Behavioral skills training (BST) is an evidence‐based approach for training individuals to implement discrete‐trial teaching procedures. Despite the effectiveness of this approach, implementing BST can be time and resource intensive, which may interfere with a clinical organization's adoption of this training format. We conducted a scoping review of studies using BST components for training discrete‐trial teaching procedures in peer‐reviewed articles between 1977 and 2021. We identified 51 studies in 46 publications involving 354 participants. We coded descriptive data on (a) participant characteristics, (b) study characteristics, (c) training conditions (including instructions, modeling, rehearsal, and feedback), and (d) training outcomes. The results indicated that studies have primarily attempted to improve the efficacy and efficiency of BST by modifying or omitting common training components. We provide best‐practice considerations for using BST to teach discrete‐trial teaching procedures and offer a research agenda to guide future investigation in this area. [ABSTRACT FROM AUTHOR]

Group-oriented contingencies are arranged to target the behavior of a group of people simultaneously. Overall, group-oriented contingencies have been shown to be effective in both decreasing problem behavior and increasing appropriate behavior. However, results are mixed regarding which type(s) of group-oriented contingency is most effective for changing behavior. In addition, although there are anecdotal reports of positive and negative side effects when using group-oriented contingencies, little research has involved direct measurement of these potential side effects. The purposes of the current study were to (a) compare the effects of three types of group-oriented contingencies for increasing on-task behavior and decreasing problem behavior, (b) determine whether implementing a group-oriented contingency for one behavior resulted in changes in a non-targeted behavior, and (c) determine how often and under what conditions side effects occurred within group-oriented contingencies conditions for two groups of preschool children. The results of the study were mixed. The results suggested that group-oriented contingencies were effective in decreasing problem behavior and increasing on-task behavior, but varied across groups as to which contingencies were the most effective at changing both behaviors. Secondary data suggested that side effects were associated with group-oriented contingencies, as well as the occurrence of problem behavior and reinforcer delivery.