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Implementation Planning to Promote Parents' Treatment Integrity of Behavioral Interventions for Children with Autism a

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Lindsay M. Fallon , Melissa A. Collier-Meek , Lisa M. H. Sanetti , b

Adam B. Feinberg & Thomas R. Kratochwill

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Bridgewater State University

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University of Massachusetts-Boston

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University of Connecticut

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University of Wisconsin-Madison Published online: 21 Aug 2015.

To cite this article: Lindsay M. Fallon, Melissa A. Collier-Meek, Lisa M. H. Sanetti, Adam B. Feinberg & Thomas R. Kratochwill (2015): Implementation Planning to Promote Parents' Treatment Integrity of Behavioral Interventions for Children with Autism, Journal of Educational and Psychological Consultation, DOI: 10.1080/10474412.2015.1039124 To link to this article: http://dx.doi.org/10.1080/10474412.2015.1039124

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Journal of Educational and Psychological Consultation, 25:1–23, 2015 Copyright © Taylor & Francis Group, LLC ISSN: 1047-4412 print/1532-768X online DOI: 10.1080/10474412.2015.1039124

Implementation Planning to Promote Parents’ Treatment Integrity of Behavioral Interventions for Children with Autism LINDSAY M. FALLON Bridgewater State University

MELISSA A. COLLIER-MEEK Downloaded by [LIndsay Fallon] at 18:05 31 August 2015

University of Massachusetts-Boston

LISA M. H. SANETTI University of Connecticut

ADAM B. FEINBERG University of Massachusetts-Boston

THOMAS R. KRATOCHWILL University of Wisconsin-Madison

Behavioral interventions delivered across home and school settings can promote positive outcomes for youth with autism spectrum disorders (ASD). Yet, stakeholders who deliver these interventions may struggle to implement interventions as intended. Low levels of treatment integrity can undermine potentially positive intervention outcomes. One way to promote implementers’ treatment integrity is Implementation Planning, a logistical planning and barrier reduction strategy that is supported by emerging schoolbased research. The current study extended the research on Implementation Planning and evaluated the effectiveness of the strategy with parents implementing a behavioral intervention at home within a Conjoint Behavioral Consultation model. The behavioral intervention aimed to increase compliance and decrease aggression for two children with ASD at home. Initially, parents struggled to deliver the intervention consistently; however, after Implementation Planning, parents’ treatment integrity increased and, subsequently, child outcomes improved. Implications for future research and consultation are presented. Correspondence should be sent to Lindsay M. Fallon, Department of Counseling and School Psychology, University of Massachusetts-Boston, 100 Morrissey Boulevard, Boston, MA 02125. E-mail: [email protected] 1


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Current estimates indicate that autism spectrum disorders (ASD) impact 1 in every 68 children (Center for Disease Control, 2014). Children with ASD vary greatly in their unique strengths and challenges, but all children diagnosed with ASD have difficulty with social communication and repeated patterns of behavior or interest, which begin in an early developmental period and cause significant impairment (American Psychiatric Association, 2013). These significant impairments are present across contexts, such as home and school (Bellini, Peters, Benner, & Hopf, 2007; Campbell, 2003; Howlin, Magiati, & Charman, 2009). Behavioral interventions implemented across home and school contexts have strong empirical support for (a) increasing prosocial behavior, (b) improving vocational outcomes, (c) increasing educational achievement, and (d) decreasing challenging behaviors for children with ASD (see National Autism Center, 2009 for a complete review). Collaboration across settings increases the relevance, impact, and sustainability of behavioral interventions to support children with ASD (Dunlap, Newton, Fox, Benito, & Vaughn, 2001; Lucyshyn, Blumberg, & Kayser, 2000; Russa, Matthews, & Owen-DeSchryver, 2014; Swiezy, Stuart, & Korzekwa, 2008).

Conjoint Behavioral Consultation Conjoint Behavioral Consultation (CBC) is an evidence-based method for systematic collaboration across stakeholders to identify problems, develop behavioral intervention plans, and monitor implementation and outcomes (Sheridan, Eagle, Cowan, & Mickelson, 2001; Sheridan & Kratochwill, 2008). In CBC, a consultant meets with a parent and teacher (or other relevant school professional) to (a) identify and evaluate a target behavior and relevant environmental variables; (b) identify, individualize, and train implementers on a behavioral intervention; and (c) evaluate the impact of the intervention once implemented (Sheridan & Kratochwill, 2008). A robust literature base supports the effectiveness of CBC across many different types of students and interventions (Kratochwill, Elliott, Loitz, Sladeczek, & Carlson, 2003; Sheridan, Warnes, et al., 2009; Sheridan, Eagle, & Doll, 2006). For instance, a recent randomized control trial found that behavioral interventions identified and individualized with CBC had a greater impact across school and home settings versus interventions selected through typical school processes (e.g., via Student Assistance Teams; Sheridan et al., 2012). Although CBC has strengths in problem identification and intervention development, limited attention has been paid to the implementation of these interventions (Collier-Meek & Sanetti, 2014; Sheridan, Welch, Kwon, Swanger-Gange, & Garbacz, 2009). Recent studies have acknowledged that inconsistent implementation may explain differential impact of interventions across settings and suggested that evaluating and supporting implementation of interventions by teachers and parents is a critical next step for the CBC framework (Sheridan et al., 2012; Swanger-Gagne, Garbacz, & Sheridan, 2009).

Implementation Planning With Parents

3


Treatment Integrity of Behavioral Interventions Indeed, behavioral interventions implemented without adequate treatment integrity (i.e., interventions implemented inconsistently or incompletely) are likely to be less effective and efficient (Sanetti & Kratochwill, 2009; Wheeler, Baggett, Fox, & Blevins, 2006). Monitoring treatment integrity is particularly important for those implementing behavioral interventions as behavioral interventions are often complex. Interventions may include several components (e.g., antecedent, teaching, consequence steps), and might involve delivery of the intervention at different times throughout the day (e.g., beginning of the day, in response to student behavior). The complexity of behavioral interventions may result in the avoidance of proscribed intervention steps (e.g., not providing attention for inappropriate behavior) and/or be related to the low levels of treatment integrity exhibited by many implementers responsible for delivering these interventions (e.g., Noell et al., 2005, 2013). In sum, for behavioral interventions to positively impact children, it is necessary to monitor implementation and ensure adequate treatment integrity (Wheeler et al., 2006). PARENTS’

TREATMENT INTEGRITY

As most implementation research attending to behavioral interventions is focused on school-based implementers, few studies have attended to parents’ treatment integrity (e.g., Solomon, Klein, & Politylo, 2012) despite the fact that that some children could benefit from home-based interventions implemented by parents (Sheridan et al., 2012; Swanger-Gagne, Garbacz, & Sheridan, 2009). For instance, parents of children with ASD report delivering behavioral interventions regularly to support their children at home (Lucyshyn et al., 2007; McConachie & Diggle, 2007). Furthermore, in CBC, collaboration usually involves parent intervention implementation (Sheridan & Kratochwill, 2008). It may be important to consider the implementation of behavioral interventions in the home setting. Consideration may be warranted as the home setting itself and parents as implementers may not be comparable to school-based intervention implementation by teachers and other school professionals (Collier-Meek & Sanetti, 2015; Swanger-Gagne et al., 2009). For instance, the home setting may be less structured than other settings (e.g., school). At school there are distinct activities with clear goals, procedures, and time constraints, while at home, many activities are more nebulous in nature. Further, parents may not have prior training or experience related to behavioral interventions, which may impact their ability to quickly learn and implement new interventions (Collier-Meek & Sanetti, 2015). Although a teacher will likely have prior experience supporting children with challenging behavior and have received related coursework and professional development, most parents do not have a background in education or be-


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havioral theory. Thus, parents must learn this information as new, without preexisting schema to incorporate behavioral intervention frameworks and practices. This may make understanding an intervention and sustaining implementation particularly challenging. In addition, parents are responsible for multiple roles in relation to their child (e.g., caregiver, provider, educational supporter), as opposed to teachers who are more clearly directed to support children’s educational development. Management of these multiple roles may make a consistent focus on intervention implementation more challenging (Collier-Meek & Sanetti, 2015). Relatedly, parents may have less time, and additional stressors that compete with their ability to implement behavioral intervention at home. Initial findings indicate that, similar to school-based professionals, parents struggle to consistently and fully implement interventions (Bonar, 2007; Connell, 2010). Parents’ struggle with implementation may be worrisome if behavioral supports are needed in the home setting to promote positive child outcomes (e.g., Solomon, Necheles, Ferch, & Bruckman, 2007).

TREATMENT

INTEGRITY PROMOTION STRATEGIES

Implementers who struggle to deliver interventions with adequate treatment integrity may benefit from a treatment integrity promotion strategy. Though a host of implementation support strategies have been proposed and evaluated with school professionals (e.g., test driving interventions, Dart, Cook, Collins, Gresham, & Chenier, 2012; self-monitoring, Simonsen, MacSuga, Fallon, & Sugai, 2013), little research has evaluated whether parents benefit from these strategies as well. The most researched strategy, Performance Feedback, involves a brief meeting between a consultant and implementer wherein treatment integrity data and intervention steps are reviewed (e.g., teachers, paraprofessionals; Noell, Witt, Gilbertson, Ranier, & Freeland, 1997; Noell et al., 2005). Meta-analyses and systematic coding per the What Works Clearinghouse single-case design criteria (Kratochwill & Levin, 2010) indicate that Performance Feedback is effective in improving treatment integrity of teachers and other school-based professionals (Solomon et al., 2012; Fallon, Collier-Meek, Maggin, Sanetti, & Johnson, 2015). Initial investigations of Performance Feedback delivered to parents showed moderate improvement in implementation but have been limited by methodological concerns or attrition issues (Bonar, 2007; Collier-Meek, 2013; Connell, 2010). It has been suggested that Performance Feedback, as currently conceptualized, may not target parents’ reasons for low levels of implementation (e.g., inexperience with behavioral interventions, competing responsibilities; Collier-Meek & Sanetti, 2015). Rather, other strategies that attend to embedding behavioral interventions into everyday practice may better account for parents’ inconsistent implementation.



IMPLEMENTATION

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PLANNING

Implementation Planning is a treatment integrity promotion strategy with emerging empirical support designed to bridge the gap between deciding to implement an intervention and engaging in that intervention consistently. This strategy can be used proactively (i.e., before intervention implementation) or if an implementer is struggling during intervention implementation (Sanetti, Kratochwill, & Long, 2013). Drawing from an adult behavior change theory (Schwarzer & Luszczynska, 2008), Implementation Planning is designed to translate an individual’s intention to implement a new behavior into behavior initiation and maintenance (i.e., intervention implementation) by defining the logistics of engaging in the behavior within a particular setting and proactively problem-solving potential barriers. Further, this planning may increase an implementer’s self-efficacy (or the belief in one’s ability to sustain a new behavior over time), which has been shown to be an important variable in sustained behavior change (Sanetti et al., 2013; Schwarzer & Luszczynska, 2008). Implementation Planning includes (a) Action Planning, wherein the implementer identifies potential modifications and implementation logistics for each intervention step, and (b) Coping Planning, wherein the implementer identifies potential barriers to ongoing implementation and identifies strategies to remediate these barriers. Implementation Planning has been shown to improve teachers’ intervention implementation (Sanetti, Collier-Meek, Long, Bryon, & Kratochwill, 2014; Sanetti, Collier-Meek, Long, Kim, & Kratochwill, 2014). To date, no study has examined the effect of Implementation Planning on parents’ treatment integrity of behavioral interventions.

Purpose of Study In this study, we sought to evaluate (a) parents’ treatment integrity when they implemented a behavioral intervention to increase compliance and decrease aggression for their child with ASD, (b) parents’ treatment integrity following Implementation Planning as compared to Standard Consultation, and (c) the relationship between parents’ treatment integrity and their child’s compliant and aggressive behavior.

METHOD Participants and Settings Two triads of child, parent, and teacher participants living in a suburban town in the Northeast were recruited for this study. Triad A included a 6-year-old Hispanic male, his mother, and female teacher. Parent A was married and had two children. Triad B included a 7-year-old Caucasian


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female, her mother, and female teacher. Parent B was married and had four children, all of whom had disabilities and received support services. Both child participants (a) had received a diagnosis of ASD by a licensed medical professional prior to the age of 3 years, and (b) were educated in a substantially separate classroom in a program for children with ASD within a typical public elementary school. Both children communicated verbally and were learning a modified version of the grade-level curriculum. The elementary school population included 51% of students eligible for free and reduced lunch (National Center for Education Statistics, 2012). The first author, an educational consultant with experience and training in behavior assessment, intervention, and analysis, served as the consultant to both triads. Consultation and intervention implementation occurred in the parents’ homes. Teachers participated in consultation meetings via telephone to promote consistency across settings.

Behavioral Intervention Both triads identified the same two behaviors to target with a behavioral intervention: increasing compliance with directions and decreasing physical aggression. Based on these target behaviors, a behavioral intervention was developed. The intervention included antecedent, teaching, and consequence strategies, though only the antecedent and consequence strategies (i.e., 13 steps) were delivered daily (see Table 1). Antecedent strategies (i.e., six daily steps) included reviewing a daily visual schedule (Dettmer, Simpson, Myles, & Ganz, 2000). As part of this, children were reminded of three positively stated behavioral expectations (Sugai & Horner, 1999) that were to be followed in order to access a daily reward (see consequence strategies below). The three positively stated behavioral expectations were the same for both students: (a) follow directions, (b) be a friend (both targeting to increase compliance), and (c) keep my cool (aimed at decreasing aggression). Teaching strategies included brief teaching sessions about the visual schedule, behavior expectations, and reinforcement system. The consultant delivered the teaching sessions to the parent, child, and teacher before the intervention was implemented so the participants would be familiar with the behavior expectations and behavioral intervention procedures. The consequence strategies (i.e., seven daily strategies) included utilizing a posted ‘‘stoplight’’ behavior warning and reinforcement system (Barbetta, 1990; Cooper, Heron, & Heward, 2007). More specifically, each day the child would start on ‘‘green,’’ but would move to ‘‘yellow’’ and then ‘‘red,’’ if repeated reminders about meeting the behavioral expectations were required. If the child again followed behavioral expectations, he/she could move back to ‘‘green.’’ If the child was ‘‘on green’’ at the end of the evening, he/she received a self-selected reward as part of the reinforcement system. This reinforcement system was introduced and reviewed daily.

TABLE 1 Intervention Steps, Assessment Method, and Mean Intervention Implementation during Baseline, Standard Consultation, and Implementation Planning Phases Mean intervention implementation

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Parent B

Parent A

Intervention steps

Assessment method

Baseline (B)

Standard consultation (SC)

Implementation planning (IP)

Baseline (B)

Standard consultation (SC)

Implementation planning (IP)

1. Press record on voice recorder 2. Review the visual schedule 3. Review ‘‘green’’ level of stoplight (i.e., remain on ‘‘green’’ if following expectations; earn a prize at the end of the night if on ‘‘green’’) 4. Review ‘‘yellow’’ (i.e., warning) and ‘‘red’’ (i.e., needs improvement) levels of stoplight 5. Determine prize to be delivered if on ‘‘green’’ at the end of the night 6. Note prize chosen on data sheet 7. Note number of times child was on ‘‘yellow’’ throughout the day 8. Note average time child was on ‘‘yellow’’ throughout the day 9. Note number of times the child was on ‘‘red’’ throughout the day 10. Note average time child was on ‘‘red’’ during the day 11. Note if child was on ‘‘green,’’ ‘‘yellow,’’ or ‘‘red’’ at end of evening 12. Note if and when prize was delivered 13. Rate compliance and aggression on the DBR scales provided Total mean (SD3 ) implementation

AR1 AR AR

0% 0% 0%

64.7% 64.7% 58.8%

92.6% 92.6% 92.6%

0% 0% 0%

31.6% 26.3% 36.8%

83.3% 91.7% 91.7%

AR

0%

64.7%

92.6%

0%

42.1%

75.0%

AR

0%

64.7%

92.6%

0%

15.8%

8.3%

PP2 PP

0% 0%

64.7% 64.7%

92.6% 96.3%

0% 0%

68.4% 68.4%

91.7% 100%

PP

0%

64.7%

96.3%

0%

63.2%

100%

PP

0%

64.7%

96.3%

0%

63.2%

100%

PP

0%

64.7%

96.3%

0%

63.2%

100%

PP

0%

58.8%

100%

0%

63.2%

100%

PP PP

0% 41.4%

5.9% 64.7%

88.9% 100%

0% 16.2%

10.5% 68.4%

0.0% 91.7%

3.2% (.11)

59.3% (18.5)

94.6% (3.2)

1.2% (.04)

47.8% (21.4)

79.5% (34.3)

1 AR

D audio recording; 2 PP D permanent product (i.e., recording on data sheet provided to parent); 3 SD D standard deviation d.

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TABLE 2 Procedural Checklists for Standard Consultation and Implementation Planning Consultation Meetings Standard Consultation Meeting Greet the parent Ask about intervention implementation Ask about the student’s response to the intervention Elicit questions or concerns from consultee about the intervention Confirm next meeting date and time Implementation Planning Meeting Opening greeting If needed, review referral concern and intervention plan Introduce the purpose of Implementation Planning Complete background information about the intervention in the Background Information Sheet Describe the process for completing the Action Plan Show the consultee the Action Plan Worksheet and identify intervention steps Discuss and decide upon revisions to the intervention steps in the Action Plan Worksheet Once revisions are completed, have consultee answer implementation and resource questions Praise consultee and summarize Action Plan Discuss how needed resources may be obtained, if applicable Transition to Coping Plan Describe the process for completing the Coping Plan Show the consultee the Coping Plan Worksheet and have consultee list and prioritize anticipated barriers Praise the consultee and collaboratively identify potential strategies to address anticipated barriers Praise consultee and summarize Coping Plan Summarize session and schedule next contact

Independent Variable The consultant completed Implementation Planning with the parent and teacher participants. Implementation Planning involves the collaborative development of (a) an Action Plan that details all steps of the intervention and related logistics (i.e., when, how often, for how long, and where, resources needed), and (b) a Coping Plan that identifies up to four potential implementation barriers and a corresponding strategy for implementing the intervention nonetheless (see Table 2). The consultant completed a procedural checklist for Implementation Planning and all consultation meetings to ensure that 100% of steps were completed.

Dependent Variables TREATMENT

INTEGRITY

Implementation of each step of the intervention was either audiotaped or resulted in a permanent product (i.e., written documentation on a data sheet provided to the parent; Noell et al., 1997, see Table 1). To calculate treatment integrity, the consultant reviewed audiotapes and data sheets to determine


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the number of intervention steps implemented as planned. To derive a daily percentage of treatment integrity, the number of intervention steps completed was divided by the total number of intervention steps. To calculate interobserver agreement, a doctoral candidate in school psychology coded 30% of the treatment integrity data and agreement between the consultant and coder was found to be high across parents (Parent A D 97.7%; Parent B D 98.7%) and overall (98.6%).


CHILD

OUTCOMES

To evaluate the children’s progress on their target behaviors systematically, parents completed Direct Behavior Ratings (DBRs) daily (Chafouleas, RileyTillman, & Christ, 2009; www.directbehaviorratings.com). DBR is a psychometrically sound tool of child behavior (Chafouleas, Christ, & RileyTillman, 2009) that is appropriate for repeated use and has been used in prior research to evaluate improvement toward behavioral goals across time (e.g., Chafouleas, Sanetti, Jaffery, & Fallon, 2012). To complete the DBRs, parent participants rated the amount of time their child was compliant and aggressive on a 0–10 scale. A rating of 0 indicated the child was not at all compliant or not at all aggressive at home that day. A rating of 10 indicated the child was compliant or aggressive the entire time he/she was home that day. SOCIAL

VALIDITY

An adapted version of the school-based Usage Rating Profile-Intervention (URP-I; Chafouleas, Briesch, Riley-Tillman, & McCoach, 2009) was used to assess parents’ perceptions of the child intervention. The URP-I typically consists of 35 items aimed at reliably assessing the acceptability (˛ D .96), understanding (˛ D .90), feasibility (˛ D .85), and the perceived need for external or systems support (˛ D .84) when implementing a school-based intervention. In this study, the URP-I was adapted; parents rated 0 (‘‘strongly disagree’’) to 6 (‘‘strongly agree’’) for items related to behavior management at home (vs. in the classroom) and consultative support (vs. support from colleagues and administrators).

Design This pilot study employed a randomized multiple-baseline design across the two triads (Kratochwill & Levin, 2010, 2014). Specifically, once child outcome Baseline data were decreasing and/or stable, the authors randomly selected a parent (Parent B) to enter the first intervention phase (Standard Consultation) while the other parent (Parent A) remained in the Baseline phase. When Parent B exhibited low levels of adherence to the behavioral intervention during the Standard Consultation phase (i.e., 2 or more days below 80%


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implementation within a week), Parent A entered the Standard Consultation phase. When both parents’ level of adherence was observed to be low and variable for at least a week (exhibited by a consistent data pattern), parents were once again randomized to enter the Implementation Planning phase and Parent B was selected. After Parent B’s data showed a high and stable level of implementation (i.e., above 80% adherence to the intervention steps for at least 5 consecutive data points in the phase), Parent A entered into the Implementation Planning phase at the next scheduled consultation meeting. The design for this pilot study includes only two participants across staggered phases so a causal relationship cannot be inferred; however, the systematic randomization across phases strengthens the design by controlling for Type I error (Edgington, 1980) and encourages tentative interpretation of the impact of Implementation Planning on parents’ treatment integrity (Kratochwill & Levin, 2010). Randomization is considered a method to increase the internal validity and statistical-conclusion validity of single-case designs (Ferron & Ware, 1995; Koehler & Levin, 1998; Kratochwill & Levin, 1978, 2010). Interested readers are encouraged to review Kratochwill and Levin (2014) for additional information on randomization within these designs.

Procedures Following recruitment, the procedures occurred across phases of CBC. Specifically, the study phases included child outcome baseline and intervention implementation, which incorporated the Standard Consultation and Implementation Planning phases. These phase and procedures are described below. RECRUITMENT The consultant recruited the two parent participants after they sought assistance from their school district for challenging behaviors exhibited in the home setting. Parents were introduced to the study, their rights as participants, and offered the opportunity to ask any questions. Once parents consented, teachers were informed about the study in a similar fashion and consented to participate. Finally, students provided verbal assent to participate. PROBLEM

IDENTIFICATION

As previously described, consultation was delivered within the format of CBC (Sheridan & Kratochwill, 2008). First, the parents met with the consultant to complete the Conjoint Problem Identification Interview. Conjoint problem identification interview. During the Conjoint Problem Identification Interview, the consultant supported parent and teacher participants to identify the target concerns and related environmental variables, develop a tentative hypotheses about behavior, and explain baseline data


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collection. Parents provided details about behavior at home and teachers confirmed the presence of similar behaviors at school. Child outcome baseline. During child outcome baseline, parents completed a daily DBR sheet to provide ratings for compliance and aggression. Parents were not yet introduced to the home-based behavior support intervention.


PROBLEM

ANALYSIS

Once baseline data collected for compliance and aggression were determined to be stable for at least 5 consecutive data points, the Conjoint Problem Analysis Interview was conducted at the next scheduled consultation meeting. Conjoint problem analysis interview. During this interview, the consultant met with the participants to review the baseline ratings provided by parents and present the framework for an individualized behavioral intervention (e.g., a plan with antecedent and teaching strategies as well as a reinforcement system). The triad collaboratively determined the specific components of the plan (e.g., when and where expectations would be reviewed, what reinforcement would be offered). Then, as part of the Conjoint Problem Analysis Interview, parent participants received direct training on how to implement specific steps of the intervention in the home. This direct training included a verbal discussion of the plan along with modeling and role-play. Teacher participants listened to this training via phone and, like parents, had the opportunity to ask questions about the intervention and its implementation. Teachers received a paper copy of plan on the following day. The consultant encouraged the teacher to utilize the strategies outlined in the plan at school, as appropriate. Intervention implementation. During intervention implementation, parents were responsible for delivering the intervention on a daily basis and meeting with the consultant weekly. Teachers did not participate in these weekly meetings. These activities persisted during the two sub-phases of intervention implementation: Standard Consultation and Implementation Planning. Standard consultation: Parents implemented the intervention in the Standard Consultation phase. During weekly meetings, the consultant provided nonspecific implementation support to the parent (i.e., asked how the intervention was going, asked about student responsiveness, answered any questions about implementation). The consultant also entered data produced by the parent (i.e., treatment integrity and child outcome data) since the last consultation session. See Table 2 for a list of steps completed during consultation meetings in the Standard Consultation phase. Parents then moved into the Implementation Planning phase based on their treatment integrity data and random assignment.

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Implementation planning: Parents completed Implementation Planning with the consultant at the start of this phase (see Table 2). During subsequent weekly meetings with the consultant during this phase, as in during the Standard Consultation phase, the consultation provided nonspecific implementation support to the parent and tracked treatment integrity and child outcome data.


TREATMENT

EVALUATION

After implementation and child outcome data were stable, the consultant met with the parent participants to conduct the Conjoint Treatment Evaluation Interview. Teachers again participated by phone. Conjoint treatment evaluation interview. During this meeting, the consultant and participants reviewed the child’s progress, revised the intervention for continued implementation, as appropriate, and ended the study. Both parents chose to continue to implement the intervention.

Data Analysis Visual analysis of treatment integrity and child outcome data was done to evaluate the trend, level, variability, overlap across phases, and immediacy of change (see Kratochwill et al., 2010). Additionally, Tau-U (Parker, Vanneest, Davis & Sauber, 2010) was utilized to evaluate the overall change from Standard Consultation to Implementation Planning for treatment integrity.

RESULTS To describe the effect of Implementation Planning, the study findings are described below as related to treatment integrity, child outcomes, and social validity.

Treatment Integrity Treatment integrity data are illustrated across phases in Figure 1. Following intervention training in the Standard Consultation phase, Parent B and Parent A demonstrated a moderate level yet highly variable treatment integrity. During this phase, Parent B’s overall average implementation was 59.3% (SD D 18.5), while her completion of individual steps ranged from 5.9% to 64.7% (see Table 1). Parent A’s overall average implementation during this phase was 47.8% (SD D 21.4), while her completion of individual steps ranged from 10.5% to 68.4% (see Table 1). After Implementation Planning, the percentage of intervention steps implemented immediately increased in level for both Parent B (increased by 35.3% to 94.6%) and Parent A

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FIGURE 1 Percentage of intervention steps completed by parents during Standard Consultation and Implementation Planning.

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(increased by 31.7% to 79.5%). Parent B’s implementation became more stable (SD decreased by 15.3 to 3.2), while Parent B’s data became more variable (SD increased by 12.9 to 34.3). There was some overlap across the Standard Consultation and Implementation Planning phases for both Parent B and Parent A, though it was more pronounced for Parent B. During this phase, Parent B’s completion of individual steps ranged from 88.9% to 100%, while Parent A’s completion of individual steps ranged from 0% to 100% (see Table 1). The Tau-U effect size supported these findings by indicating a 71.8% increase for both participants from Standard Consultation to Implementation Planning.


Child Outcomes Parents’ DBR ratings for compliance and aggression across phases are depicted in Figure 2 and Table 3. During Baseline, both Parent B (M D 4.5; SD D .2) and Parent A (M D 4.8; SD D .6) reported that, on average, their children were compliant less than half of the time. Parent B (M D 2.4; SD D .8) and Parent A (M D 3.4; SD D .1) also reported, on average, moderately low levels of aggression. After introduction of the intervention in the Standard Consultation phase, the ratings for Child B indicated an increasing trend for compliance (M D .5; SD D .2) and decreasing trend for aggression (M D .6; SD D .7). This change was relatively immediate (i.e., within 3 data points) and with little overlap across phases. For Child A, ratings for compliance increased (M D .8; SD D .6) and aggression decreased (M D .1; SD D .5). This change was immediate (i.e., within 3 data points) and although there was some overlap between ratings made in the Baseline and Standard Consultation phases for aggression, there was relatively little overlap for compliance. For Parent A, ratings for compliance became more variable in Standard Consultation from Baseline while the ratings for aggression were less variable.

TABLE 3 Student Outcome Data (i.e., Parent Ratings of Compliance and Aggression) by Phase Standard consultation

Baseline

Parent B Compliance Aggression Parent A Compliance Aggression

Implementation planning

MB (SDB )

Median

MSC (SDSC )

Median

MIP (SDIP )

Median

4.5 (1.2) 2.4 (0.8)

4.5 2.0

7.5 (1.2) 0.6 (0.7)

8.0 1.0

8.6 (0.6) 0.4 (0.8)

9.0 0.0

4.8 (0.6) 3.4 (3.1)

5.0 4.5

6.8 (1.6) 2.1 (1.5)

6.5 2.0

6.7 (1.3) 2.1 (1.9)

7.0 2.0



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FIGURE 2 Parents’ Direct Behavior Ratings for child’s compliance and aggression during Standard Consultation and Implementation Planning.

After Implementation Planning, the level of Child B’s compliance increased while the variability decreased (M D .6; SD D .6), and her aggression decreased (M D 0.4; SD D .8). For both behaviors, there was some overlap between phases and the change was relatively immediate. After Implementation Planning, for Child A, there was only a negligible difference in variability for compliance (M D .7; SD D .3) and aggression (M D .1; SD D .9). However, the improvement after the phase change was immediate and there was an increasing trend for compliance and decreasing trend for aggression.

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Social Validity Per ratings on the URP-I, parents found the behavior intervention to be highly acceptable (Parent B D 6.0; Parent A D 5.5), understandable (Parent B D 6.0; Parent A D 5.1), fairly feasible (Parent B D 5.6; Parent A D 4.6), but requiring consultative support to implement (Parent B D 6.0; Parent A D 5.5).


DISCUSSION To achieve the positive outcomes that can result from behavioral interventions for children with ASD, the interventions must be implemented consistently and completely (Wheeler et al., 2006). Treatment integrity may be particularly important for the delivery of behavioral interventions where it is necessary for an implementer to deliver intervention components fluently and consistently throughout the day in response to the student’s behavior, while avoiding proscribed intervention steps (Campbell, 2003; Wheeler et al., 2006). Though developed in keeping with consistent principles and logic, behavioral interventions are individually developed based on the child with ASDs unique profile of strengths, challenges, and contingencies. Thus, behavioral interventions developed and individualized in consultation require careful attention to implementation to ensure the student receives the intervention as planned and, as such, may benefit from the intervention. Behavioral interventions are often implemented across settings and, as such, may be delivered by parents and school personnel (Horner, Carr, Strain, Todd, & Reed, 2002). In these cases, it is particularly critical for consistency of implementation. As little research has attended to parents’ implementation (Collier-Meek & Sanetti, 2015), we evaluated two parents’ treatment integrity as they implemented a behavioral intervention to decrease challenging behaviors for their children with ASD. Consistent with studies of school-based personnel (Solomon et al., 2012: Fallon et al., 2015), Parents A and B struggled to implement the behavioral intervention consistently and fully. Before receiving support, the parent participants exhibited distinct patterns of implementation; Parent B delivered the intervention with high levels, but inconsistent treatment integrity, while Parent A delivered the intervention with more moderate and variable treatment integrity. These patterns of treatment integrity warrant implementation support, particularly because of the need for consistent, high levels of treatment integrity necessary for behavioral interventions to impact child outcomes. As participants exhibited low levels of treatment integrity during Standard Consultation, we applied Implementation Planning. By defining the logistics of intervention implementation, Implementation Planning has been shown to improve treatment integrity of school-based personnel delivering



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behavioral interventions (e.g., Sanetti, Collier-Meek, Long, Byron, & Kratochwill, in press; Sanetti, Collier-Meek, Long, Kim, & Kratochwill, 2014). For both parent participants, there was an increase in percentage of intervention steps implemented and decrease in variability once this treatment integrity support strategy was delivered. This improvement is promising; other studies of delivering implementation supports (e.g., Performance Feedback) to parents have not resulted in improved treatment integrity (Bonar, 2007; Collier-Meek, 2013; Connell, 2010). It may be that Implementation Planning, as it is uniquely focused on logistical planning and barriers identification, may be particularly well suited for supporting the use of behavioral interventions (Collier-Meek & Sanetti, 2014). Further, the activities involved in Implementation Planning (e.g., identifying logistics and problem-solving barriers) may be aligned with the issues related to parents’ struggle with implementation at home. That is, parents may need help embedding intervention implementation into their routines and practices at home, rather than simply receiving feedback on their treatment integrity (as consistent with Performance Feedback; Collier-Meek & Sanetti, 2015). Behavioral interventions implemented as planned are associated with positive outcomes for youth with ASD (Campbell, 2003; Howlin et al., 2009). In this study, the relationship between parents’ implementation and their children’s behavior are mixed; Child B received the highest average ratings for compliance and lowest average ratings for aggression during the Implementation Planning phase, while compliance and aggression ratings for Child A remained consistent across intervention phases. These findings may be due to the parent participants’ treatment integrity. Parent B delivered the intervention with high levels of treatment integrity after Implementation Planning so improvements in child outcomes would be expected. Parent A had a more moderate but consistent level of treatment integrity following support. Based on these levels of implementation, it may not be appropriate to expect Child B to make significant improvements related to compliance and aggression.

Limitations This study provides initial support for Implementation Planning as a strategy to bolster parents’ implementation of behavioral interventions for their children with ASD. Limitations of this investigation include the small sample size, which impacts the conclusions that can be drawn. Despite the systematic use of randomization to strengthen this research design, two participants may preclude the demonstration of a functional relationship between Implementation Planning and parents’ treatment integrity. This study also relied on permanent products to document both treatment integrity and student outcome measures. Although treatment integrity permanent products and DBR have been shown to be able to be used to collect reliable and valid

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data (e.g., Chafouleas, Riley-Tillman, et al., 2009; Noell et al., 1997), this investigation did not include research observations to confirm the accuracy of these data.

Future Directions Review of the literature and results from the current study inform recommendations for both research and practice.


IMPLICATIONS

FOR RESEARCH

Although there is a vast body of research supporting the use of behavioral interventions to support students with ASD, parents are often involved in delivery of home-based behavioral supports (Dunlap et al., 2001; Lucyshyn et al., 2007). As such, it is critical that future studies investigate ways to feasibly and effectively support parents’ implementation of home-based behavioral interventions (Collier-Meek & Sanetti, 2015). Implementation Planning may be one strategy to promote parents’ treatment integrity. This pilot serves as the foundation for future studies to document the utility and effectiveness of such a strategy to assist parents’ delivery of interventions to support their children with ASD. Subsequent studies in this line of Implementation Planning research will evaluate the efficacy of this strategy in varied applied settings, including the home. Future studies might include diverse participant samples and/or use of multiple methods assessment (e.g., self-report ratings and direct observations). Furthermore, more research is needed to investigate the different patterns of responding that occurred in the current study. Given the results presented above, a research question for subsequent empirical study might target if Implementation Planning is perhaps a better strategy for parents who implement interventions with great variability versus those who have moderate levels of treatment integrity during pre-Implementation Planning phases. It may also be beneficial to examine the effects (e.g., student outcomes) of Implementation Planning across settings (e.g., home, school) if and when treatment integrity improved in one or both settings. IMPLICATIONS

FOR PRACTICE

Data presented in the current study, specifically the Standard Consultation phase, provide evidence for the importance of consultants attending to parents’ treatment integrity. For both parents, treatment integrity levels were not high and stable, raising concern for parents’ implementation of home-based intervention plans. As previously described, behavioral interventions implemented without adequate treatment integrity are likely to be less effective and efficient (Collier-Meek & Sanetti 2014; Sanetti & Kratochwill, 2009; Sheridan et al., 2009; Wheeler et al., 2006). Although the authors recognize that implementers may have different patterns of implementation, practitioners should


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look to the emerging literature base on strategies to promote treatment integrity to provide support to parents implementing home-based behavioral interventions as well as was intended during intervention design. Results from this and previous studies indicate that there are time- and resourceefficient methods of promoting treatment integrity when it is low (e.g., Performance Feedback, Implementation Planning). Practitioners may better impact the children they support in consultation by being familiar and comfortable implementing treatment integrity promotion strategies when parents’ implementation of home-based behavioral interventions is inadequate.


REFERENCES American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Barbetta, P. M. (1990). Red light–green light: A class-wide management system for students with behavior disorders in primary grades. Preventing School Failure, 34, 14–19. Bellini, S., Peters, J. K., Benner L., & Hopf, A. (2007). A meta-analysis of schoolbased social skills interventions for children with autism spectrum disorders. Remedial and Special Education, 28, 153–162. Bonar, A. M. (2007). The effects of performance feedback on parents’ treatment integrity using conjoint behavioral consultation. Dissertation Abstracts International Section A, 68. Campbell, J. M. (2003). Efficacy of behavioral intervention for reducing problematic behaviors in persons with autism: A quantitative synthesis of single-subject research. Research in Developmental Disabilities, 24, 120–138. Center for Disease Control (2014). Prevalence of autism spectrum disorder among children aged 8 years: Autism and developmental disabilities monitoring network, 11 Sites, United States, 2010. Surveillance Summary, 63, 1–21. Chafouleas, S. M., Briesch, A. M., Riley-Tillman, T. C., & McCoach, D. B. (2009). Moving beyond assessment of treatment acceptability: An examination of the factor structure of the Usage Rating Profile-Intervention (URP-I). School Psychology Quarterly, 24, 36–47. Chafouleas, S. M., Christ, T. J., & Riley-Tillman, T. C. (2009). Generalizability and dependability of scaling gradients on direct behavior ratings. Journal of Educational Measurement, 69, 157–173. Chafouleas, S. M., Riley-Tillman, T. C., & Christ, T. J. (2009). Direct Behavior Rating (DBR): An emerging method for assessing social behavior within a tiered intervention system. Assessment for Effective Intervention, 34, 195–200. Chafouleas, S. M., Sanetti, L. M. H., Jaffery, R., & Fallon, L. M. (2012). An evaluation of a class-wide intervention package involving self-management and group contingency on classroom behavior of middle school students. Journal of Behavioral Education, 21, 34–57. Collier-Meek, M. A. (2013). Increasing parents’ treatment integrity to a homework intervention through conjoint behavioral consultation and performance feedback. Doctoral Dissertations. Paper 91.


20

Fallon et al.

Collier-Meek, M. A., & Sanetti, L. M. H. (2014). Treatment integrity assessment of consultation and intervention implementation: A review of conjoint behavioral consultation studies. Journal of Educational and Psychological Consultation 24, 55–73. doi:10.1080/10474412.2014.870482 Collier-Meek, M. A., & Sanetti, L. M. H. (2015). Considering parents’ implementation: Role of adherence, program differentiation, and implementation support. Manuscript submitted for publication. Connell, J. E. (2010). Applications of performance feedback: Consultation in the home. International Journal of Behavioral Consultation and Therapy, 6, 17– 24. Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis (2nd ed.). Upper Saddle River, NJ: Prentice Hall. Dart, E. H., Cook, C. R., Collins, T. A., Gresham, F. M., & Chenier, J. S. (2012). Test driving interventions to increase treatment integrity and student outcomes. School Psychology Review, 41, 467–481. Dettmer, S., Simpson, R. L., Myles, B. S., & Ganz, J. B. (2000). The use of visual supports to facilitate transitions of students with autism. Focus on Autism and Other Developmental Disabilities, 15, 163–169. Dunlap, G., Newton, J. S., Fox, L., Benito, N., & Vaughn, B. (2001). Family involvement in functional assessment and positive behavior support. Focus on Autism and Other Developmental Disabilities, 16, 215–221. Edgington, E. S. (1980b). Validity of randomization tests for one-subject experiments. Journal of Educational Statistics, 5, 235–251. Fallon, L. M., Collier-Meek, M. A., Maggin, D. M., Sanetti, L. M. H., & Johnson, A. H. (2015). Is performance feedback an evidence-based intervention? A systematic review and evaluation of single-case research. Exceptional Children, 81, 227– 246. Ferron, J., & Ware, W. (1995). Analyzing single-case design: The power of randomization tests. The Journal of Experimental Education, 63, 167–178. Horner, R. H., Carr, E. G., Strain, P. S., Todd, A. W., & Reed, H. K. (2002). Problem behavior interventions for young children. Journal of Autism and Developmental Disorders, 32, 423–446. Howlin, P., Magiati, I., & Charman, T. (2009). Systematic review of early intensive behavioral interventions for children with autism. American Journal on Intellectual and Developmental Disabilities, 114, 23–41. Koehler, M. J., & Levin, J. R. (1998). Regulated randomization: A potentially sharper analytical tool for the multiple baseline design. Psychological Methods, 3, 206– 217. Kratochwill, T. R., Elliott, S. N., Loitz, P. A., Sladeczek, I., & Carlson, J. S. (2003). Conjoint consultation using self-administered manual and videotape parentteacher training: Effects on children’s behavioral difficulties. School Psychology Quarterly, 18, 269–302. doi:10.1521/scpq.18.3.269.22574 Kratochwill, T. R., & Levin, J. R. (1978). What time-series designs may have to offer educational resources. Contemporary Educational Psychology, 3, 273–329. Kratochwill, T. R., & Levin, J. R. (2010). Enhancing the scientific credibility of singlecase intervention research: Randomization to the rescue. Psychological Methods, 15, 124–144. doi:10.1037/a0017736.



21

Kratochwill, T. R., & Levin, J. R. (2014). Single-case intervention research: Methodological and statistical advances. Washington, DC: American Psychological Association. Lucyshyn, J., Albin, R., Horner, R. H., Mann, J. C., Mann, J. A., & Wadsworth, G. (2007). Family implementation of positive behavior support with a child with autism: A longitudinal, single case experimental and descriptive replication and extension. Journal of Positive Behavior Interventions, 9, 131–150. Lucyshyn, J. M., Blumberg, E. R., & Kayser, A. T. (2000). Improving the quality of support to families of children with severe behavior problems in the first decade of the new millennium. Journal of Positive Behavior Interventions, 2, 113–115. McConachie, H., & Diggle, T. (2007). Parent implemented early intervention for young children with autism spectrum disorder: A systematic review. Journal of Evaluation in Clinical Practice, 13, 120–129. doi:10.1111/j.1365-2753.2006. 00674.x National Autism Center (2009). National standards reports: The national standards projects addressing the need for evidence base practice guidelines for autism spectrum disorders. Randolph, MA: National Autism Center. National Center for Education Statistics. (2012). CCD Public school data 2011–2012 school year. Retrieved from http://nces.ed.gov/globallocator/ Noell, G. H., Gansle, K. A., Mevers, J. L., Knox, R. M., Mintz, J. C., & Dahir, A. (2013). Improving treatment plan implementation: A meta-analysis of single subject designs. Journal of Behavior Education, 23, 168–191. doi:10.1007/s10864-0139177-1 Noell, G. H., Witt, J. C., Gilbertson, D. N., Ranier, D. D., & Freeland, J. T. (1997). Increasing teacher intervention implementation in general education settings through consultation and performance feedback. School Psychology Quarterly, 12, 77–88. Noell, G. H., Witt, J. C., Slider, N. J., Connell, J. E., Gatti, S. L., : : : Duhon, G. J. (2005). Treatment implementation following behavioral consultation in schools: A comparison of three follow-up strategies. School Psychology Review, 34, 87– 106. Parker, R. I., Vannest, K. J., Davis, J. L., & Sauber, S. B. (2010). Combining nonoverlap and trend for single case research: Tau-U. Behavior Therapy. 42, 284– 299. doi:10.1016/j.beth.2010.08.006. Russa, M. B., Matthews, A. L., & Owen-DeSchryver, J. S. (2014). Expanding supports to improve the lives of families of children with autism spectrum disorder. Journal of Positive Behavior Interventions. Online preprint. Sanetti, L. M. H., Collier-Meek, M. A., Long, A. C. J., Byron, J. R., & Kratochwill, T. R. (in press). Increasing teacher treatment integrity of behavior support plans through consultation and implementation planning. Journal of School Psychology. Sanetti, L. M. H., Collier-Meek, M. A., Long, A. C. J., Kim, J. S., & Kratochwill, T. R. (2014). Using implementation planning to increase teachers’ adherence and quality to behavior support plans. Psychology in the Schools, 51, 879–895. Sanetti, L. M. H., & Kratochwill, T. R. (2009). Toward developing a science of treatment integrity: Introduction to the special series. School Psychology Review, 38, 445–459.


22

Fallon et al.

Sanetti, L. M. H., Kratochwill, T. R., & Long, A. C. J. (2013). Applying adult behavior change theory to support mediator-based intervention implementation. School Psychology Quarterly, 28, 47–62. Schwarzer, R., & Luszczynska, A. (2008). How to overcome health-compromising behaviors: The health action process approach. European Psychologist, 13, 141– 151. doi:10.1027/1016-9040.13.2.141 Sheridan, S. M., Bovaird, J. A., Glover, T. A., Garbacz, A., Witte, A., & Kwon, K. (2012). A randomized trail examining the effects of conjoint behavioral consultation and the mediating role of the parent-teacher relationship. School Psychology Review, 41, 23–46. Retrieved from: http://www.nasponline.org/publications/ spr/abstract.aspx?ID=3354 Sheridan, S. M., Eagle, J. W., Cowan, R. J., & Mickelson, W. (2001). The effects of conjoint behavioral consultation: Results of a four-year investigation. Journal of School Psychology, 39, 361–385. Retrieved from http://www.eric.ed.gov/ERIC WebPortal/detail?accno=EJ634434 Sheridan, S. M., Eagle, J. W., & Doll, B. (2006). An examination of the efficacy of conjoint behavioral consultation with diverse clients. School Psychology Quarterly, 21, 396–417. doi:10.1037/h0084130 Sheridan, S. M., & Kratochwill, T. R. (2008). Conjoint behavioral consultation: Promoting family-school connections and interventions. New York, NY: Springer. Sheridan, S. M., Warnes, E. D., Woods, K. E., Blevin, C. A., Magee, K. L., & Ellis, C. (2009). An exploratory evaluation of conjoint behavioral consultation to promote collaboration among family, school, and pediatric systems: A role for pediatric school psychologists. Journal of Educational and Psychological Consultation, 19, 106–129. doi:10.1080/10474410902888566 Sheridan, S. M., Welch, G., Kwon, K., Swanger-Gange, M. S., & Garbacz, S. A. (2009). Fidelity measurement in consultation: Psychometric issues and preliminary examination. School Psychology Review, 4, 476–495. Retrieved from: http://www. eric.ed.gov/ERICWebPortal/search/detailmini.jsp?_nfpb=true&_&ERICExt Search_SearchValue_0=EJ867976&ERICExtSearch_SearchType_0=no&accno= EJ867976 Simonsen, B., MacSuga, A. S., Fallon, L. M., & Sugai, G. (2013). Teacher selfmonitoring to increase specific praise rates. Journal of Positive Behavior Interventions, 15, 3–13. Solomon, B. G., Klein, S. A., & Politylo, B. C. (2012). The effect of performance feedback on teachers’ treatment integrity: A meta-analysis of the single-case literature. School Psychology Review, 41, 160–175. Solomon, R., Necheles, J., Ferch, C., & Bruckman, D. (2007). Pilot study of a parent training program for young children with autism. Autism, 11, 205–224. doi:10. 1007/s10803-009-0825-1 Sugai, G., & Horner, R. (1999). Discipline and behavioral support: Practices, pitfalls, and promises. Effective School Practices, 17, 10–22. Swanger-Gagne, M. S., Garbacz, A. S., & Sheridan, S. M. (2009). Intervention integrity within conjoint behavioral consultation: Strategies for working with families. School Mental Health, 1, 131–142. doi:10.1007/s12310-009-9012-y Swiezy, N., Stuart, M., & Korzekwa, P. (2008). Bridging for success in autism: Training and collaboration across medical, educational, and community systems. Child and Adolescent Psychiatric Clinics of North America, 17, 907–922.


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Wheeler, J. J., Baggett, B. A., Fox, J., & Blevins, L. (2006). Treatment integrity: A review of intervention studies conducted with children with autism. Focus on Autism and Other Developmental Disabilities, 21, 45–54.


Lindsay M. Fallon, PhD, is an Assistant Professor in the Department of Counseling and School Psychology at the University of Massachusetts-Boston. She received her PhD in school psychology from the University of Connecticut in 2013 and has worked as a behavioral consultant in Massachusetts. She is interested in research and consultation with school staff, families and community members to implement evidence-based practices with high levels of treatment integrity. She is also interested in promoting positive behavioral outcomes for children with disabilities and children who are culturally and linguistically diverse. Melissa A. Collier-Meek, PhD, is an Assistant Professor of School Psychology at the University of Massachusetts-Boston. Her research interests include treatment integrity assessment and implementation support in schools, homes, and community settings. She received her PhD in school psychology in 2013 from the University of Connecticut and has worked to support teachers, families, and teams implement evidence-based practices in Connecticut and Massachusetts. Lisa M. H. Sanetti, PhD, is an Associate Professor in the Neag School of Education at the University of Connecticut. She has authored over 50 refereed articles, book chapters, and books. Her primary areas of research interest involve implementation science and schoolbased mental health. Prior to joining the faculty at University of Connecticut, she was a behavioral consultant and provided assessment and intervention services to children with significant disabilities and/or mental health issues and their families and educators. Adam B. Feinberg, PhD, is a clinical professor at the University of Massachusetts-Boston. He is both a licensed psychologist, as well as a board certified behavior analyst with over 15 years of experience in behavioral health supporting children with disabilities in both schools and community settings. He received his PhD in school psychology from Lehigh University in 2003. Areas of expertise and research interests include system level change relative to positive behavior intervention & supports (PBIS), and response to intervention in academic areas. Thomas R. Kratochwill, PhD, is the Sears Roebuck Foundation-Bascom Professor at the University of Wisconsin-Madison, Director of the School Psychology Program, and a licensed psychologist in Wisconsin. He is the author of over 200 journal articles and book chapters. He has written or edited over 30 books and has made over 300 professional presentations. His research interests include problem solving consultation, transportability of evidence-based interventions to practice, childrens anxiety disorders, and single-case research design and data analysis. Note: The authors report that to the best of their knowledge neither they nor their affiliated institutions have financial or personal relationships or affiliations that could influence or bias the opinions, decisions, or work presented in this manuscript.