ERIC EJ1162926: Using the System of Least Prompts to Teach Personal Hygiene Skills to a High School Student with Comorbid Visual Impairment and Autism Spectrum Disorder

2017·0.28 MB·English

by  ERIC

CE Article
Using the System of Least Prompts
to Teach Personal Hygiene Skills
to a High School Student
with Comorbid Visual Impairment
and Autism Spectrum Disorder
Kristi M. Probst and Virginia L. Walker
Structured abstract: Introduction: This study evaluated the effectiveness of a
workshop and follow-up coaching sessions on the implementation of the system
of least prompts procedure by classroom team members and explored whether
this intervention resulted in personal hygiene skill acquisition by a male high
school student with comorbid visual impairment and autism spectrum disorder.
Methods: Implementation fidelity data were analyzed descriptively through
visual analysis. A multiple baseline design across behaviors was utilized to
evaluate the effectiveness of the system of least prompts procedure on student
skill acquisition. Results: Implementation fidelity was high and increased over
the course of the study: paraeducator 1: 93.9% (range, 70 to 100%); paraeducator
2: 78.2% (range, 11 to 90%); and special education teacher: 94.1% (range, 35 to
100%). In addition, the student’s independent performance improved from baseline
to intervention across each targeted skill, with Tau-U scores as follows: cleaning the
augmentative and alternative communication device: 0.78; washing hands: 0.76; and
brushing teeth: 0.92. Classroom team members found both the training procedures
and the system of least prompts intervention to be of value and effective. Discussion:
During intervention, classroom team members implemented the system of least
prompts with fidelity and the student mastered each skill. These results are promising
and add to the significantly limited literature on instructional interventions for
students with comorbid visual impairment and autism spectrum disorder. Implica­
tions for practitioners: Classroom team members can effectively be taught to use the
system of least prompts with students with comorbid visual impairment and autism
spectrum disorder. Furthermore, the intervention might be used to increase inde­
pendent functioning for students with these comorbid conditions.
R
esearchers have suggested that the than in the general population (0.6%;
prevalence of autism spectrum disorder in Centers for Disease Control and Preven­
individuals with visual impairment may tion [CDC], 2012). However, the exact
be higher (11.6%; Lund & Troha, 2008) prevalence rate is difficult to determine
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©2017 AFB, All Rights Reserved Journal of Visual Impairment & Blindness, November-December 2017
CE Article
(Mukkaddes, Kilincaslan, Kucucyazici, with visual impairments. The system of
Sevketoglu, & Tuncer, 2007). A strong least prompts was the most frequently
foundation of both evidence-based prac­ used procedure among studies, though
tices and pre-and in-service training oppor­ none of the literature targeted daily living
tunities relevant to supporting individuals skills instruction. Although only 12 stud­
with autism spectrum disorder exists (Na­ ies met the quality indicators for single-
case research set forth by Horner and
tional Professional Development Center on
colleagues (2005), the results of the re­
Autism Spectrum Disorder [NPDC], 2014).
view support prompting as an evidence-
However, far less research has been con­
based practice that is effective when
ducted to explore instructional practices
teaching new skills to individuals with
and effective training methods of those
visual impairments. These studies pro­
working with learners with comorbid di­
vide promising results. However, addi­
agnoses of visual impairment and autism
tional intervention research is necessary
spectrum disorders.
to identify instructional practices that can
A few literature reviews have been
be used to develop strong educational
conducted to identify effective interven­
programs encompassing a wide range of
tions for individuals with autism spec­
skills relevant for learners with comorbid
trum disorder and sensory impairments
visual impairment and autism spectrum
(Banda, Griffin-Shirley, Okungu, Ogot, &
disorder (for example, life skills, aca­
Meeks, 2014), communication develop­
demic skills, and embedded skills such as
ment of children with visual impairments
communication) across a broad spectrum
(Parker & Ivy, 2014), and literacy of
of age groups.
students with visual impairments and ad­ Gense and Gense (2011) suggest that
ditional disabilities (Parker & Pogrund, the best way to develop a learning envi­
2009). Not surprisingly, many of the ronment that meets the unique needs for
identified interventions among these support of individuals with comorbid vi­
reviews incorporated components of sual impairment and autism spectrum dis­
evidence-based practices from the field of order is to address:
autism spectrum disorder (for example,
prompting or reinforcement; NPDC, 1. sensory and biological needs;
2014). Ivy and Hatton (2014) conducted a 2. appropriate reinforcement;
systematic review of 22 single-case inter­ 3. opportunities to communicate and func­
vention studies to determine if prompting tional communication systems;
procedures could be identified as an 4. concrete supports to assist with partic­
ipation and understanding;
evidence-based practice for individuals
5. task demands;
6. systematic, thoughtful instruction;
EARN CES ONLINE 7. data-driven decision making; and
by answering questions on this article. 8. appropriate-level instruction (p. 331).
For more information,
visit: http://jvib.org/CEs.
Although this framework establishes an
overall approach for delivering instruction,
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Journal of Visual Impairment & Blindness, November-December 2017 ©2017 AFB, All Rights Reserved
CE Article
specific interventions and evidence-based trum disorder, given the well-established
practices have not been thoroughly re­ research base documenting the efficacy
searched for the population of students with and social validity of such practices
this dual diagnosis. Gense and Gense across a wide range of skills and learner-
(2011) argue that, to efficaciously address support needs (Browder, Wood, Thomp­
the needs of students with comorbid visual son, & Ribuffo, 2014; Spooner, Knight,
impairment and autism spectrum disorder, Browder, & Smith, 2012).
the program of instruction must be wide- Another consideration when planning
ranging and deliberately designed, and must instruction for these learners is the extent
integrate an expanded core curriculum (for to which support providers are equipped
example, communication, play and social, to deliver instruction and other related
adaptive, organizational, orientation and services to this population. The reliance
mobility, or career and life education skills). on paraeducators to support students with
Moreover, Li (2009) emphasized the im­ autism spectrum disorder has continued
portance of both combining and adapting to increase but, unfortunately, these para-
interventions developed for students with educators often have not received ade­
comorbid autism spectrum disorder and vi­ quate training to do so, thus placing the
sual impairment in order to meet the spe­ educational responsibility for students
cific needs for support of this population. Li who often have the most intense needs for
suggests that an education program devel­ support in the hands of the least prepared
oped for these students should include strat­ individuals (Rispoli, Neely, Lang, &
egies that target daily living skills (for ex­ Ganz, 2011). Researchers have identi­
ample, personal hygiene and money fied various effective paraeducator
management) in addition to a number of training strategies but have yet to ex­
other important skill areas (for example, plore paraeducator-implemented inter­
communication, orientation and mobility, ventions among learners with visual im­
social, engagement in appropriate tasks, and pairments and autism spectrum disorder
visual efficiency). Li also advocated for (Brock & Carter, 2013; Walker &
strategies based on applied behavior analy­ Smith, 2015). This area clearly requires
sis, since much of the literature on more investigation, given the unique
evidence-based practices for learners with needs for support of this population and
autism spectrum disorder is characterized the important role of paraeducators in
by such practices (NPDC, 2014). System­ the provision of instruction and related
atic instruction is an approach that is de­ services under the supervision of teach­
rived from the principles of applied be­ ers and other professionals.
havior analysis and relies on methodical The purpose of the current study was to
prompting, reinforcement, and fading train classroom team members to imple­
procedures. Different prompting proce­ ment an intervention based on evidence-
dures much like those reviewed by Ivy based practices from the field of autism
and Hatton (2014), including the system spectrum disorder that was based on
of least prompts, may be viable instruc­ evidence-based practices to teach a stu­
tional practices for learners with comor­ dent with a comorbid diagnosis of visual
bid visual impairment and autism spec­ impairment and autism spectrum disorder
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©2017 AFB, All Rights Reserved Journal of Visual Impairment & Blindness, November-December 2017
CE Article
personal hygiene skills, which are an in­ classroom team members and to engage
tegral part of daily living skills. Although in instructional activities. The classroom
education personnel had attempted to was composed of six students, ages 14 to
teach these skills for many years to the 21 years, with a variety of disabilities
participant, none of the interventions had (intellectual disability, autism, and phys­
relied upon systematic instruction and the ical disabilities). A special education
student never achieved independent func­ teacher, peers with disabilities, and para-
tioning. The following research questions educators were present during the first
were addressed: routine. The second and third routines,
brushing teeth and washing hands, took
1. Are classroom team members able to place in bathrooms that were not accessi­
ble to the general school population. Typ­
implement the system of least prompts
ically, adults other than classroom team
procedure with high levels of fidelity
members were not present in the bath­
after participating in a workshop and
room settings. All training workshops oc­
follow-up coaching sessions?
curred in the classroom when students
2. Does implementation of the system of
were not present and coaching sessions
least prompts result in an improvement
were delivered either in the bathroom or
in the acquisition of personal hygiene
in the classroom where the student naturally
skills for a student with comorbid vi­
performed the targeted skill. Prior to the
sual impairment and autism spectrum
study, informed consent was obtained from
disorder?
all classroom team members and the stu­
3. Are the training procedures (workshop
dent’s parent; the student also gave assent.
and follow-up coaching) and the sys­
tem of least prompts procedure con­
CLASSROOM TEAM PARTICIPANTS
sidered socially valid?
Two paraeducators and one special educa­
tion teacher participated in training sessions
Methods
and implemented intervention throughout
SETTING AND PARTICIPANTS
the duration of the study. The team mem­
The system of least prompts intervention
bers were selected to participate in the study
was implemented across three settings in
because of their daily involvement with the
a public high school in the Midwest of the
student participant. All three team members
United States. The student participant re­
were familiar with the concept of prompting
ceived instruction in a special education but had reported no formal training in the
program focused on the development of system of least prompts procedure prior to
life skills to promote effective transition the study. As such, participants indicated
from school to the community. The first that the system of least prompts was not
set of tasks or routine, cleaning the stu­ used prior to the onset of the study. Para-
dent’s augmentative and alternative com­ educator 1 was a 26-year-old Caucasian fe­
munication device, took place in a self- male with a bachelor’s degree in special
contained special education classroom in education. She had not completed the
which the student regularly utilized such course work necessary to obtain her teach­
a device to communicate with peers and ing license in the state in which she
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Journal of Visual Impairment & Blindness, November-December 2017 ©2017 AFB, All Rights Reserved
CE Article
resided, but had four years of experience visual clutter and complexity, increased
as a special education teacher in a differ­ visual response time, illumination, and
ent state. At the time of the study, she had consistent routines to provide consistency
four years of experience as a paraeduca­ for fluctuating vision) and received an
tor. Paraeducator 2 was a 60-year-old annual consultation with a teacher of vi­
Caucasian female with a bachelor’s de­ sually impaired students. Due to the na­
gree in special education. She had worked ture of Garrett’s disabilities, he required
as a special education teacher and ele­
specialized instruction with frequent and
mentary general education teacher before
intense levels of support to participate in
working as a paraeducator for two years.
academic and life skills instruction (for
The special education teacher was a 44­
example, frequent repetition, ongoing su­
year-old Caucasian female who had a
pervision, and slower pacing of educa­
bachelor’s degree in special education
tional content). During academic instruc­
and a master’s degree in teaching and
tion, Garrett often engaged in challenging
leadership. At the time of the study, she
behavior (for example, hitting, biting
had 22 years of experience as a special
himself, screaming, and spitting) when
education teacher, 11 of which were spent
directed to engage in a task. At the time of
working with students with severe dis­
the study, Garrett utilized a DynaVox
abilities.
speech-generation device and picture
STUDENT PARTICIPANT communication symbols to communicate
at a multiword level (non-rote combina­
Garrett (a pseudonym) was a 17-year-old
tion of two or more words or symbols).
boy with a diagnosis of visual impair­
ment, autism spectrum disorder, and in­
tellectual disability. He was selected as a DEPENDENT MEASURES
participant based on the following inclusion
To determine the effectiveness of the
criteria: documented diagnosis of visual im­
workshop and training sessions, an imple­
pairment and autism spectrum disorder, tar­
mentation fidelity checklist was used to
geted skills aligned with the student’s Indi­
measure the accuracy with which team
vidualized Education Program (IEP), and
members applied the intervention strate­
an average daily school attendance of 90%.
gies across all intervention sessions. This
At the time of the study, Garrett wore
list included the following components
glasses throughout the duration of the
that were specific to the system of least
school day due to his visual impairment
prompts procedure: delivered task direc­
(cortical visual impairment, astigmatism
tion; provided student with a three-second
corrected by his prescribed glasses, ambly­
opia, and hyperopia); no exact acuity or response interval to perform steps in the
field restrictions were reported due to an task analysis; provided reinforcement if
inability to obtain an accurate assessment. the student performed the step correctly
Overall, his functional vision nega­ within the response interval; and provided
tively affected his access to the curricu­ the next prompt in the hierarchy if the
lum, and he required modifications to in­ student did not perform the step correctly
teract with curricular materials (reduced within the response interval.
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©2017 AFB, All Rights Reserved Journal of Visual Impairment & Blindness, November-December 2017
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Table 1
Task analyses.
Skill
Cleaning AAC device Washing hands Brushing teeth
1. Remove one wipe from container 1. Pump soap onto one hand 1. Retrieve storage box
2. Place wipe on AAC device 2. Rub front of hands together 2. Pick up toothpaste
3. Wipe “face” of AAC device, 3. Rub back of hands together 3. Open toothpaste
touching all 4 corners (cleaning 4. Turn on water 4. Pick up toothbrush
80% or more of the screen) 5. Place both hands under water 5. Squeeze toothpaste on brush
4. Carry wipe to trash can 6. Turn off water 6. Close toothpaste
5. Drop wipe in trash can 7. Retrieve paper towel(s) 7. Put toothpaste in storage box
8. Dry both hands 8. Turn on water
9. Throw paper towel(s) into 9. Put brush under water
trash can 10. Turn water off
11. Bring toothbrush to mouth
12. Brush top left back teeth
13. Brush bottom left back teeth
14. Brush front top teeth
15. Brush front bottom teeth
16. Brush back top right teeth
17. Brush back bottom right teeth
18. Put toothbrush in storage box
19. Put storage box away
To evaluate the effectiveness of the sys­ food, or substances and the scent of soap;
tem of least prompts intervention, Garrett’s washing hands—lack of visible dirt, food,
completion of each skill was recorded or substances and the scent of soap; and
across all sessions. Prior to the study, the brushing teeth—lack of visible food par­
first author, in collaboration with Gar­ ticles and the scent of toothpaste. The
rett’s special education teacher, created a purpose of this supplementary measure of
task analysis for each skill in order to skill completion was to ensure that accu­
permit direct observation and accurate rate completion of the skill (that is, per­
calculation of skill completion. Table 1 forming steps in the task analysis accu­
contains the task analysis for each tar­ rately) ultimately produced the intended
geted skill: cleaning the augmentative and and desirable outcome.
alternative communication device, wash­
ing hands, and brushing teeth. During base­ DATA COLLECTION AND
line and intervention probe sessions, inde­ INTEROBSERVER AGREEMENT
pendent completion of the skill (without The primary observer, a doctoral student
prompting) was measured, whereas during in special education and the first author of
the intervention sessions both independent the current study, observed in person or
and prompted skill completions were mea­ viewed video recordings of classroom
sured. In addition, the outcome of skill team members and the student during tar­
completion was measured across all ses­ geted routines two to four times a week.
sions (Iwata & Becksfort, 1981). Quality When the primary observer was unable to
outcomes were defined as follows: clean­ conduct live observations, the special edu­
ing the augmentative and alternative com­ cation teacher used an iPad to record inter­
munication device—lack of visible dirt, vention implementation. The individual
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Journal of Visual Impairment & Blindness, November-December 2017 ©2017 AFB, All Rights Reserved
CE Article
recording the session held the iPad to pleted each skill and the quality of the
permit close-up recording. Observation outcomes across all baseline and inter­
sessions never exceeded 30 minutes. vention sessions. Accuracy data were
It should be noted that team members converted into a percentage by dividing
were not exposed to the system of least the total number of independently com­
prompts intervention prior to the work­ pleted steps by the total number of steps
shop and coaching sessions and, there­ in the analysis. During system of least
fore, implementation fidelity was not prompts intervention sessions, the level of
measured during baseline. During inter­ prompting necessary to elicit the correct
vention, the classroom team members student response was recorded to monitor
provided Garrett with one opportunity to the effectiveness of the response prompts
perform the targeted skill during naturally included in the prompt hierarchy. The
occurring routines. The primary observer secondary observer independently evalu­
recorded whether the team member cor­ ated skill completion across 23% of base­
rectly implemented the intervention by line and intervention sessions using pro­
indicating “yes,” “no,” or “no opportu­ cedures similar to those outlined earlier.
nity” for each intervention component Interobserver agreement for student skill
across each step in the task analysis ex­ completion was 100%.
cept for delivery of the task direction.
Implementation fidelity was calculated as DESIGN
the overall percentage of intervention This study was approved by the Institu­
components implemented correctly dur­ tional Review Board at Illinois State Uni­
ing a given session. When implementa­ versity. To evaluate the effects of the
tion fidelity fell below 80% accuracy, the workshop and coaching sessions on the
researcher provided additional coaching. implementation of the system of least
Coaching occurred six times over the prompts intervention by classroom team
course of the study, with most sessions members, a descriptive analysis of imple­
(n = 3) conducted with paraeducator 2 in mentation fidelity data during intervention
response to her lack of provision of rein­ was conducted. Participants did not imple­
forcement. Paraeducator 1 and the special ment the intervention during baseline, and
education teacher received one and two thus the design of this study permitted
coaching sessions, respectively. A trained measurement adherence during intervention
secondary observer, a graduate student in only (treatment fidelity; Ledford & Wolery,
communication disorders, conducted in­ 2013). As such, a functional relation be­
terobserver agreement observations by tween the training procedures and imple­
measuring the extent to which the system mentation fidelity could not be established.
of least prompts procedures were applied A multiple baseline across three behav­
across 23% of intervention sessions. iors (targeted skills; Gast & Ledford,
Overall implementation fidelity agree­ 2014) design was used to measure the
ment was high (96%). effectiveness of the system of least
To measure improvements in Garrett’s prompts intervention on the acquisition of
skill completion, the primary observer re­ skills by the student. Baseline data were
corded the accuracy with which he com­ collected simultaneously for all skills
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©2017 AFB, All Rights Reserved Journal of Visual Impairment & Blindness, November-December 2017
CE Article
until a relatively stable trend (for exam­ data were collected across a minimum of
ple, low variability in which approxi­ four sessions until stable and predictable
mately 80% of data points fell within a levels of student behavior were observed.
20% range of the median level; Gast &
Ledford, 2014) was established. In a stag­ Workshop
gered fashion, classroom team members Prior to the system of least prompts
participated in a workshop and subse­ intervention and after baseline data col­
quently implemented the intervention to lection, each classroom team member
address each targeted skill. Visual exam­ individually participated in a brief
ination of graphed data was used to de­ workshop session during which partic­
termine the effects of the intervention for
ipants received one-on-one training
all skills and included an analysis of
from the first author. The workshop
changes in independent response across
lasted approximately 20 minutes and
baseline phases, changes in level across
was delivered via interactive Power-
phases, changes in trend, and latency of
Point, discussion, and role-playing,
change (Gast & Ledford, 2014). To sup­
with a culminating performance assess­
plement visual analysis, effect sizes were
ment involving role-playing. Although
calculated across each routine using Tau-U,
the overall structure of the workshop
an effect-size metric appropriate for single-
remained the same across classroom
case research (Parker, Vannest, Davis, &
team members, the content was tailored
Sauber, 2011).
to specifically address each targeted
skill. The PowerPoint presentation in­
CONDITIONS
cluded general information about pro­
Over the course of the study, classroom
cedure, the response prompts that
team members participated in a workshop
formed the prompt hierarchy, the re­
training session and subsequently imple­
sponse interval to be used with the stu­
mented the system of least prompts inter­
dent, and a video of the trainer model­
vention to teach Garrett three personal
ing implementation of the intervention
hygiene skills, while receiving periodic
with a different student. In addition, the
follow-up coaching as needed.
classroom team members were provided
Baseline with a written task analysis of the tar­
geted skill and the intervention. The
Prior to introducing the intervention,
trainer and classroom team members re­
classroom team members conducted
baseline sessions across the three targeted viewed each written document as part of
routines. Each team member delivered a the workshop. Before moving to the in­
task direction but did not provide instruc­ tervention phase of the study, team
tion to elicit a correct student response. members were required to achieve 80%
The classroom team was aware that base­ on the performance assessment to dem­
line data were being collected for the pur­ onstrate their knowledge and ability to
poses of a research study focused on implement the system of least prompts
prompting, but specific details about the via role-play; all three members met
project were unknown to them. Baseline this criterion on the first attempt.
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Journal of Visual Impairment & Blindness, November-December 2017 ©2017 AFB, All Rights Reserved
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Intervention using the system Garrett reached mastery criteria for clean­
of least prompts ing his augmentative and alternative com­
Following the workshop session, each munication device and washing his hands,
team member implemented the procedure maintenance data were collected on a
weekly basis over the course of six and
to teach the following skills: cleaning the
eight weeks, respectively. Maintenance
augmentative and alternative communica­
data were not collected for brushing teeth
tion device (paraeducator 1), washing
due to the school year ending. During
hands (paraeducator 2), and brushing
maintenance sessions, the team member
teeth (special education teacher). The sys­
delivered the task direction but did not
tem of least prompts involves a well-
provide assistance or reinforcement, sim­
defined prompting hierarchy, whereby
ilar to those procedures applied during
response prompts are systematically de­
baseline and intervention probes.
livered from the least amount of support
to the most amount of support (control­
Coaching
ling prompt; Brown, McDonnell, & Snell,
Throughout the intervention, the first au­
2015). Typically, reinforcement is deliv­
thor coached team members when imple­
ered contingent on correct responses
mentation fidelity dropped below 80%.
when implementing the system of least
Paraeducator 1 required one coaching
prompts, with continuous schedules of re­
session, which occurred immediately af­
inforcement being used until the student
ter the first intervention session. The ses­
begins to acquire the skill (Brown et al.,
sion lasted approximately 10 minutes and
2015). In the current study, team mem­
included a review of the written docu­
bers delivered a task direction (for exam­
ments previously provided (that is, task
ple, “Your hands are dirty; you need to
analysis of the targeted skill and the sys­
wash them.”), applied a three-second re­
tem of least prompts procedure), a video
sponse interval, and delivered a prompt
review, and a reminder to use verbal re­
according to the hierarchy for incorrect
inforcement when Garrett performed each
student responses as follows: verbal (stat­
step of the task analysis. The paraeduca­
ing the step in the task analysis), gesture
tor and trainer viewed the video of the
(pointing), and partial physical prompt
session, identifying times when reinforce­
(placing two fingers on the student’s wrist
ment was necessary but was omitted. Fol­
to guide him). Reinforcement in the form lowing the video review, the paraeducator
of verbal praise was delivered contingent and first author reviewed the written doc­
on correct student responses. Probe ses­ uments, clarified the procedure, and iden­
sions were conducted after every three tified strengths of the session.
intervention sessions to monitor the stu­ Paraeducator 2 and the special educa­
dent’s progress; these procedures were tion teacher required three and two coach­
similar to those used during baseline data ing sessions, respectively, due to a lack of
collection. The criterion for mastery of provision of verbal reinforcement, with
each targeted skill was completion of the each session lasting approximately 15
skill with 100% accuracy (unprompted) minutes. All coaching sessions were con­
across three consecutive sessions. After ducted immediately after the intervention
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©2017 AFB, All Rights Reserved Journal of Visual Impairment & Blindness, November-December 2017
CE Article
sessions. Team members were coached in Results
the same manner as paraeducator 1 was; IMPLEMENTATION FIDELITY
however, paraeducator 2 required addi­
Figure 1 displays the percentage of pro­
tional clarification with supplementary
cedural elements that were correctly im­
role-playing.
plemented by classroom team members
during the system of least prompts inter­
TRAINING FIDELITY vention. Overall, implementation fidelity
To assess the extent to which workshop was high and improved over the course of
and coaching sessions were conducted as intervention. Average fidelity scores were
intended, the trainer completed a check­ as follows: paraeducator 1: 94% (range,
list of training elements that was signed 70 to 100%); paraeducator 2: 78% (range,
by the classroom team member at the con­ 11 to 90%); and special education teacher:
clusion of each training session. Based on 94% (range, 35 to 100%). All classroom
these checklists, the trainer followed the team members displayed the lowest imple­
workshop training and coaching protocols mentation fidelity during the first three in­
with 100% accuracy across all workshop tervention sessions (range, 11 to 77%),
and coaching sessions. which necessitated additional training in the
form of coaching for all three team mem­
SOCIAL VALIDITY bers.
At the conclusion of the study, classroom
team members completed a social validity PERFORMANCE OF THE STUDENT
questionnaire to determine whether the Figure 1 also displays the percentage of
training procedures were effective and if steps performed independently for each
the intervention was useful, produced targeted skill. Garrett’s independent per­
effective results, and was usable in the formance improved from baseline to in­
classroom. The following open-ended tervention for each targeted skill, and im­
items were included in the questionnaire: provement in independent responding
(a) How effective do you think the re­ was documented during both the probe
search study was? (b) Was the research and intervention sessions. During base­
study meaningful? Why or why not? (c) line, Garrett independently completed an
Would you use the intervention for other average of 70% of the steps (range, 60 to
activities or skills? If yes, how? (d) 80%) that were necessary to clean his
Would the intervention be useful for other augmentative and alternative communica­
students? If yes, how? (e) How easily was tion device. This percentage increased to
the intervention incorporated into your 95% (range, 80 to 100%) during interven­
regular classroom routines? and (f) What tion probes. Garrett maintained high lev­
suggestions would you have for improv­ els of performance post-intervention: His
ing the program? Participants received performance was 100% accurate for a ma­
the survey via e-mail and were asked to jority of maintenance probes. Similarly,
return it electronically or in written form. Garrett’s handwashing completion im­
Respondents completed the survey in 5 proved from baseline to intervention, as evi­
minutes or less. denced by an average baseline performance
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Journal of Visual Impairment & Blindness, November-December 2017 ©2017 AFB, All Rights Reserved