Behavioral Intervention: Severe Behavior Follow-up Program

Background:

Many individuals with autism engage in problematic behaviors.  Severe problem behaviors may require treatment in intensive settings such as day-treatment programs.  Following implementation of a successful treatment in the day-treatment setting, the treatment needs to be generalized to the individuals natural environment (e.g., home), which requires treatment implementation by the individual’s caregivers (Allen & Warzak, 2000).  Positive long-term outcomes for individuals who received interventions in intensive day- treatment settings for severe problem behavior are correlated with high treatment integrity of caregivers upon discharge (Witt et al., 1997).  If caregivers are not able to implement treatment with high fidelity, long-term gains are unlikely.  However, to date there are few longitudinal studies examining outcomes and the integrity of treatment implementation following discharge from intensive day-treatment programs.

 Objectives:

The purpose of the current investigation was to examine caregiver treatment integrity following training that occurred as part of an admission to an intensive day-treatment program that specialized in the treatment of severe problem behavior. Specifically at issue was whether caregivers maintained high fidelity of treatment implementation and if treatment integrity was associated with rates of problem behavior in the natural environment following discharge.

  Methods:  

Six caregivers of children referred to an intensive day-treatment program that specialized in the assessment and treatment of severe problem behavior participated.  It was standard practice of the program to train caregivers to implement function-based treatments in the final week of their child’s admission.  Training consisted of didactics, role plays, and in vivo sessions.  Each participant was required to demonstrate all treatment components in role-play and at 90% procedural fidelity for 3 10 min sessions in a row prior to discharge.   

Follow-up services were provided in the families’ homes and communities for 12 visits that occurred during the six months following discharge.  During these visits, a trained therapist observed and recorded data on child problem behavior and caregiver implementation of the treatment package.  If needed, additional training was provided in the form of didactic instruction, modeling, rehearsal, and performance feedback.

Results:  

Overall, rates of problem behavior that were recorded at the moment of discharge persisted following discharge.  Furthermore, treatment results generalized across community settings (e.g., home, the grocery store, school, etc.) for some participants.  Results indicate that caregivers who maintained high treatment integrity also observed an 80% or greater reduction in problem behavior upon discharge from the day-treatment program.  The number of treatment components or complexity of treatment did not seem to affect treatment integrity. 

Conclusions:  

Results of the current investigation emphasize the importance of providing follow-up services to families upon discharge from intensive day-treatment facilities.