ERIC EJ697211: An Enriched Teaching Program for Reducing Resistance and Indices of Unhappiness among Individuals with Profound Multiple Disabilities

2005·0.09 MB·English

by  ERIC

JOURNALOFAPPLIEDBEHAVIORANALYSIS 2005, 38, 221–233 NUMBER2 (SUMMER2005)
AN ENRICHED TEACHING PROGRAM FOR REDUCING
RESISTANCE AND INDICES OF UNHAPPINESS AMONG
INDIVIDUALS WITH PROFOUND MULTIPLE DISABILITIES
CAROLYN W. GREEN AND DENNIS H. REID
CAROLINABEHAVIORANALYSISANDSUPPORTCENTER
AND
JEANNIA H. ROLLYSON AND SUSAN C. PASSANTE
WESTERNCAROLINACENTER,MORGANTON,NORTHCAROLINA
Weevaluatedanenrichedteachingprogramforreducingresistanceandindicesofunhappiness
displayed by 3 individuals with profound multiple disabilities during teaching sessions. The
program involved presentation of preferred activities before, during, and after each teaching
session, discontinuation of identified nonpreferred activities, and a brief break and preferred
activity following occurrence of resistance. Implementation of the enriched teaching program
was accompanied by reductions in resistance and indices of unhappiness for each participant.
Results also indicated no negative impact of the program on participant performance of the
teaching steps or staff teaching proficiency. Staff questionnaire responses provided a degree of
socialvalidationfortheobservedchangesinthatstaffreportedtheparticipantslikedtheenriched
teaching program more than the traditional teaching process. Directions for future research
discussed include identifying critical aspects of the overall program and the potential relation
betweenteaching proficiency andthe program’s enrichmenteffectiveness.
DESCRIPTORS: unhappiness,responsive teaching, profound multiple disabilities
_______________________________________________________________________________
One of the most challenging populations One common activity that can interfere with
facing service providers in developmental dis- apparent enjoyment among people with pro-
abilities is people who have profound multiple found multiple disabilities is provision of
disabilities. These individuals represent the teaching services. Various teaching procedures
extreme lower end of the continuum of people are aversive, as evidenced by problem behavior
withprofounddisabilitiesintermsofseverityof reinforced by escape from instructional
challenges (Logan et al., 2001). The profound demands (Ebanks & Fisher, 2003; Vaughn &
cognitive, sensory, and physical disabilities of Horner, 1997). Despite the potential aversive-
this population often result in minimal re- ness and the recognized difficulty in teaching
sponsestotypicalprogramservices(Loganetal., this population (Ivancic & Bailey, 1996; Logan
1998; Bailey, 1981). Due in part to problems et al., 1998), teaching services are still frequent-
encounteredwithtraditionalprograms,increased ly considered necessary to maintain existing
attention is being directed to programs that skills or to attempt to increase independence
focus more on enhancing quality of life among when possible (Reid, Phillips, & Green, 1991).
these individuals by increasing enjoyment with Several strategies exist for altering teaching
daily activities (Ivancic & Bailey, 1996; Green procedures that occasion problem behavior
& Reid, 1999). among the general population of people with
developmental disabilities. One strategy is
RequestsforreprintsshouldbeaddressedtoDennisH. functional communication training (Durand
Reid at the Carolina Behavior Analysis and Support & Carr, 1991). However, most research with
Center, P.O. Box 425, Morganton, North Carolina
this approach has involved people with less
28680.
doi:10.1901/jaba.2005.4-04 pronounced challenges than profound multiple
221
222 CAROLYN W. GREEN et al.
disabilities, and may be contraindicated for the strategy to overcome resistance among people
latter population. Functional communication with profound multiple disabilities. If teaching
training requires that a person acquire skills to procedures can be carried out in a manner that
request and obtain specific types of reinforce- learners appear to enjoy, or at least do notseem
ment (Durand, 1999). Due to the difficulty in to seriously dislike, then caregivers responsible
teaching functional skills to people with pro- for teaching may be more likely to persist with
found multiple disabilities, teaching them more teaching attempts.
conventionalmeanstoobtaindesiredeventscan The purpose of this investigation was to
be problematic or time consuming. Caregivers evaluate an enriched teaching program for
can become frustrated and abandon teaching reducing resistance to teaching and accompa-
attempts or implement programs incompletely nying negative affect among people with pro-
(cf. Reid & Parsons, 2002, chap. 4). found multiple disabilities. The intent was to
Another strategy for reducing problem be- reduce resistance and negative affect without
havior during teaching sessions is escape extinc- detrimentally affecting the learner’s response to
tion (see Carr, Coriaty, & Dozier, 2000, for the teaching procedures (i.e., enriching the
a summary). This approach may also be teaching process is of questionable value if it
contraindicated for people with profound reduced the learners’ skill development or
maintenance). The enriched teaching program
multiple disabilities. Problem behavior during
was based on a program designed to decrease
teachingsessions may not be harmful(e.g., self-
indices of unhappiness during therapeutic
injury or aggression) but may represent non-
exercises (Green & Reid, 1999). This investi-
compliance in the form of physically resisting
gation attempted to extend work with the
teaching procedures accompanied by negative
previousprograminseveralways.First,whereas
affect. In light of the difficulty these individuals
the Green and Reid program focused on
experience in acquiring more advanced com-
exercise activities designed by a physical thera-
munication skills, such behavior may be their
pist to maintain range of motion and muscle
sole means of expressing displeasure. If such is
tone, the current program focused on teaching
the case, it may not be desirable to extinguish
procedures designed to enhance or maintain
this behavior, because it allows individuals to
functional skills. Second, the earlier program
indicate activities that they dislike. Hence, the
focused directly on indices of unhappiness as
behaviorcan be helpful foridentifying activities
the dependent variable in terms of contingen-
that can be removed from the daily routine to
cies built into the program, whereas the current
make their day less unpleasant if the activities
program placed contingencies on resistance
are not considered critical to their overall
during teaching and monitored effects on
support plan (Green & Reid, 1999).
indices of unhappiness. Third, in light of the
A third strategy that has had success with
potential impact on caregivers of conducting
some individuals in reducing problem behavior
procedures that appear to be disliked, this
occasioned by teaching procedures and related
investigation added social validity measures
demands is to enrich the procedures to make
concerning caregiver views of the impact of
them potentially more preferred or less aversive
the program on individual enjoyment.
(Foster-Johnson,Ferro,&Dunlap,1994;Long,
Hagopian, DeLeon, Marhefka, & Resau, in
METHOD
press). In consideration of the concerns with
functional communication training and escape Setting and Participants
extinction, enhancing the preferred nature of The settings were two homes in a residential
teaching procedures appears to be a reasonable center for adults with profound multiple
ENRICHED TEACHING FOR REDUCING RESISTANCE 223
disabilities and significant medical needs. The 18 months of experience in a direct support
participants were 3 women who resided in the role. One staff person conducted all of Pam’s
two homes. Each participant had profound teaching sessions, and 1 carried out all of
cognitivedisabilities,wasnonambulatory,exhib- Tami’s.ForBea,therewere4primarystaffwho
ited no functional speech, and had impaired carriedoutmost(65%)ofherteachingsessions.
vision. Pam and Bea lived in one of the homes The remainder of Bea’s sessions were carried
with 11 other individuals, and Tess lived in the out by 4 substitute staff, who filled in for the
other home with 14 individuals. Pam was 48 primary staff when they were absent from
years of age, had spastic quadriplegia, a seizure work or otherwise unavailable to conduct
Bea’s session.
disorder, tuberous sclerosis, and a partial
hearing loss. She received nutritional intake
Behavior Definitions
through a gastrostomy tube. Bea was 48 years
The primary target behavior was resistance,
of age and had marked scoliosis and severe
defined as pulling away from the teacher’s
contractures. Tami was 31 years of age and had
touch, continuing to hold an arm or hand in a
left hemiparesis and a seizure disorder. These
contracted position when the teacher attempted
individuals were selected based on requests to
to move the arm or hand, continuing to keep
the person-centered teams that served individ-
fingers closed when the teacher attempted to
uals in each home regarding resistance to
open a closed fist, or turning away from the
formal teaching programs. Indirect functional
teacher. A second primary target behavior,
assessments (Durand & Crimmins, 1992;
indices of unhappiness, represented the measure
Iwata, 1995) indicated that resistance likely
of negative affect. Social validation data have
served an escape function. The teams were also
supported use of unhappiness indices as rep-
requested to consider individuals who appeared
resenting displeasure or unhappiness among
to dislike teaching sessions. The 3 participants
people with profound multiple disabilities
were subsequently selected from recommenda-
(Green & Reid, 1996; Parsons, Reid, &
tions from the teams and baseline observations
Green, 2001). Indices of unhappiness were
that substantiated resistance during ongoing defined as in previous research (Green & Reid,
teaching sessions. 1996; Ivancic, Barrett, Simonow, & Kimberly,
All experimental procedures were carried out 1997) as any facial expression or vocalization
by staff who routinely worked in the partic- typically considered to be an indicator of
ipants’livingareasandwereassignedtoconduct unhappiness among people without disabilities,
teaching programs as part of their regular suchasfrowning,grimacing,crying,andyelling
duties. Each staff member had received training without smiling.
in how to teach with the Teaching Skills Secondary target behaviors included skill
TrainingProgram(Parsons&Reid,1999)prior performance on the teaching tasks and staff
to being assigned to each participant’s teaching teaching proficiency. Measurement of skill
program. With one exception, all staff were performance was based on the degree of each
direct support personnel, with backgrounds participant’s independence in completing each
similar to those of typical direct support staff step of the task-analyzed teaching program (see
in public residential facilities (Bradley, Taylor, Parsons,Reid,&Green,1993,foradescription
Mulkern, & Leff, 1997). The exception was of the required prompt level as a measure of
a supervisor who was one of several staff who responsiveness to teaching among people with
carried out Bea’s program. The supervisor had profound multiple disabilities). The teaching
amaster’sdegreeand20yearsofexperience.All program protocols required staff to record the
other staff had a high school degree and at least prompt level required for the participant to
224 CAROLYN W. GREEN et al.
completeeachstepintheprogramtaskanalysis. 10-s partial-interval process. Observations were
Four levels of prompts were incorporated: conducted for 3 min immediately before teach-
completing a step following a verbal prompt ing was initiated, throughout the program
(Level 4), a partial physical prompt at the implementation, and for 3 min immediately
participant’s elbow (Level 3), a partial physical after the program was completed. The periods
prompt at the wrist (Level 2), and full physical immediatelybeforeandafterimplementationof
guidance by guiding the participant’s hand teaching procedures represented a natural, non-
throughthestep(Level1).Followingateaching demand situation in the participants’ regular
session, the numerical value of each prompt environment (hence, resistance could not occur
level required to complete a step was averaged by definition, but indices of unhappiness could
across all steps and teaching trials. Hence, the occur). Interobserver agreement checks were
higher the numerical value, the greater the conducted during at least 21% of all teaching
degree of relative independence the participant sessions for each participant, including each
demonstrated in completing the steps. experimental condition. Interobserver agree-
Staff proficiency in carrying out teaching ment was calculated by dividing the number
programs was monitored to ensure that pro- of agreements by the number of agreements
ficiency was not detrimentally affected by the plus disagreements and multiplying by 100%.
intervention. Teaching proficiency was defined Overall and nonoccurrence agreement averaged
based on the procedure of Parsons and Reid at least 98% for resistance (respective session
(1999),whichtargetsfoursetsofteachingskills. rangesof97%to100%and96%to100%)and
The first set, order of teaching, pertained to unhappiness indices (respective ranges of 82%
following the steps of the task analysis in the to 100% and 75% to 100%). Occurrence
correct order (i.e., as listed in the task analysis). agreement averaged 81% (range, 0% to 100%)
The second set, prompting, required a least-to- for resistance and 88% (range, 33% to 100%)
most assistive instructional strategy in which for unhappiness indices.
each successive prompt (if more than one Interobserver agreement for participant per-
prompt was used) involved more assistance formance during a teaching session was calcu-
than the previous prompt. The third set, lated by dividing the smaller average prompt
reinforcement, required providing a positive level for a session recorded by one observer by
consequence following the last correct step in the larger average recorded by the second
the task analysis and not providing a positive observer and multiplying by 100%. Inter-
consequenceforanyincorrectlyperformedstep. observer agreement averaged 78% (range, 50%
The fourth set of teaching skills, error correc- to 100%). For staff teaching proficiency,
tion, required the staff member to provide interobserver agreement was calculated by di-
increased assistance sufficient to ensure that the viding the smaller percentage of teaching steps
participant completed the step without an error scored correct by one observer by the larger
if the participant exhibited a behavior incom- percentage scored correct by the second observ-
patible with a task-analyzed step. Each of these er and multiplying by 100%. Inter-
teaching procedures was scored as correctly observer agreement averaged 89% (range, 55%
or incorrectly performed for each step. (‘‘Not to 100%).
applicable’’ was scored if, for example, no error
occurredanderrorcorrectionwasnotrequired.) Experimental Conditions
Baseline. During baseline, the staff con-
Observation System and Interobserver Agreement ducted a teaching program according to their
The observation system for resistance and usual procedures. Each teaching program was
indices of unhappiness involved a continuous scheduled to be conducted once each weekday.
ENRICHED TEACHING FOR REDUCING RESISTANCE 225
Observations occurred on a probe basis, first trial, the teacher conducted several pre-
averaging two times per participant per week. ferred activities. For Pam, the preferred activ-
Eachteachingprogramwasinplacepriortothe ities involved talking to her for 1 to 2 min,
investigation as part of each participant’s turning on soft music, turning on a lighted
ongoing service plan. Each program involved make-up mirror, and reducing extraneous noise
discrete trials for task-analyzed steps (if there by turning off a television or radio that was on
was more than one step to the program). in the immediate area. For Bea, the activities
Pam’s program was designed to teach her to included playing soft music, ensuring that food
hold her hairbrush for 5 s, representing a one- was on the table when she was first escorted to
step program. Each session involved three the table (i.e., in contrast to being escorted to
discrete trials. Bea’s program involved teaching the table and waiting for food to be delivered),
her to scoop food with a spoon, using an eliminating wiping her face prior to the first
adaptiveplatewithascoopguard.Theprogram trial, providing a small drink of liquid, pro-
consisted of two steps (picking up the spoon viding a choice of condiments (e.g., salt or no
and scooping food on the spoon), with five salt on an item) based on approach responses
trials per session. Tami’s program involved followingitemsampling,givingherasmalltaste
teachingherto wipe her facewith a napkin and of each food item, and reducing any extraneous
consisted of the steps of taking the napkin to noise from the immediate environment. For
her face and moving the napkin across her Tami, theproceduresconductedbeforethe first
mouthafterthestaffmemberplacedthenapkin teachingtrialincludedturningonalightnextto
in her hand. Each session included five trials. a mirror in front of her, softly talking to her,
Enriched teaching program. Similar to the placing cleanser and lotion under her nose to
Green and Reid (1999) program used to allow her to smell the items, placing a warm
decrease indices of unhappiness during pre- wrap around her neck, massaging her arms and
scribedexercises,theenrichedteachingprogram hands with lotion for a few seconds, and
consisted of four components. The first com- massaging her face with cleanser for a few
ponentinvolvedidentifyingpreferreditemsand seconds. Each set of preferred activities con-
activities for each participant. However, in ducted before the first teaching trial typically
contrast to the Green and Reid program in lasted 2 to 3 min and never exceeded 5 min.
which items and activities were based on results The third component of the enriched teach-
of systematic preference assessments supple- ing program involved two procedures con-
mentedwithstaffopinion,potentialpreferences ducted during the actual teaching trials. One
were based solely on staff opinion regarding procedure involved continuing the environ-
most preferred items and activities as listed in mental arrangements established immediately
each participant’s person-centered plan. priortothetrials(e.g.,keepingthemusiconfor
The second component involved conducting Pam and Bea, keeping the light on for Tami).
preferred activities immediately prior to imple- The second procedure involved briefly (less
menting a teaching program and eliminating than 10 s) discontinuing a teaching trial if
any ongoing activities that had been pre- resistance was displayed and providing a
viously identified as nonpreferred in partic- preferred activity (brushing Pam’s hair for
ipants’ person-centered plans. Conditions were several strokes, giving a bit of sweet food to
arrangedtobeginateachingsessionexactlyasin Bea, and massaging Tami’s arm with lotion
baseline (i.e., the teacher obtained the necessary while softly talking to her). Immediately
teaching materials and approached the partic- following the preferred activity, the trial was
ipant) but immediately prior to beginning the resumed. In this manner, the same number of
226 CAROLYN W. GREEN et al.
teaching trials was conducted and completed as Program Acceptability and Social Validity
in baseline, but the completion of a given trial Measures
may have been briefly interrupted (i.e., the Following the study, staff were asked to
participant did not escape performing the trial complete a five-item acceptability questionnaire
but experienced a break before completion). and turn it in anonymously to a mailbox. The
The final component of the enriched teaching questionnaire was provided to Pam’s and
program involved adding a preferred activity Tami’s teachers as well as to the 4 staff who
immediately following the last teaching trial (in functionedasteachersduringbothexperimental
addition to the contingent praise provided as conditions for Bea. All six questionnaires were
part of the formal teaching process). The completed and delivered to the mail box. The
preferred activities involved continued brushing first four questions consisted of a seven-point
(in a styling manner) of her hair and providing Likertscale.Thefirsttwoquestionspertainedto
a choice of hair barrettes for Pam, sitting and how much the participant liked or disliked the
rockinginarockingchairforBea,andescorting teaching program the way it used to be carried
Tami to a quiet place by herself and giving her out and the way it was currently carried out,
skim milk and a sweet snack. These activities respectively (7 5 liked a whole lot; 1 5 disliked
lasted 5 to 10 min. a whole lot). Question 3 asked how much
Staff were trained to conduct the enriched the current program increased or decreased the
teaching procedures through written and vocal degreetowhichtheparticipantenjoyedthepro-
instructions, demonstration, and practice in gram relative to the previous way the program
implementing the procedures with feedback. In was carried out (7 5 increased a whole lot;
addition, a rationale was provided regarding 15decreasedawholelot),andQuestion4asked
the desire to conduct the teaching program in if the current program was easier or harder to
a manner that was less unpleasant for the carry out relative to the way the program was
participant. formerlycarriedout(75awholeloteasier;15
a wholelotharder).Question5 askedif thestaff
Program Integrity Measures
member would rather conduct the program the
Due to the relatively large number of wayitwasformerlycarriedoutorthewayitwas
procedures involved in the program for each
currently carried out.
participant, an experimenter observed at least
86% of sessions for each participant to obtain Experimental Design
procedural integrity measures (Cooper, Heron, The experimental design consisted of a mul-
& Heward, 1987, chap. 10). A checklist was tiple probe across 2 participants and a sub-
prepared based on the descriptions of the sequent quasiexperimental AB design with 1
enriched teaching procedures, and the experi- participant.
menter recorded whether each procedure was
correctly carried out. For Pam and Tami, the
RESULTS
procedural integrity measures were high, aver-
agingatleast90%implementedcorrectlyacross Resistance and indices of unhappiness
sessions. Procedural integrity was somewhat decreased for all 3 participants during the
lower for Bea, averaging 70%. The lower enriched teaching program relative to baseline.
average for Bea’s staff was due primarily to 2 Figure 1 presents the percentage of observation
substitutestaff,whocarriedouttheprogramon intervals in which resistance and indices of
one and two sessions, respectively. These unhappiness occurred during teaching. Resis-
teachers omitted steps from all components tance behavior decreased from a baseline
but also correctly implemented other steps. average of 36% (range, 0% to 100%) for Pam
ENRICHED TEACHING FOR REDUCING RESISTANCE 227
Figure1. Percentageofobservationintervalswithresistanceandindicesofunhappinessforeachparticipantduring
eachteaching session for bothexperimental conditions.
to an average of 6% during the enriched and 3% (range, 0% to 18%) during the
teaching program (range, 0% to 20%), and program. Follow-up observations while staff
indices of unhappiness decreased from 15% continued to carry out the enriched teaching
(range,0%to50%)to0%.Bea’sresistanceand program after formal completion of the inves-
indices of unhappiness decreased from respec- tigationacrossperiodsof2to5 weeksindicated
tive averages of 27% (range, 0% to 60%) and that the decreased levels of resistance behavior
20% (range, 0% to 60%) during baseline to and unhappiness indices were maintained for
respective averages of 7% (range, 0% to 18%) bothPamandBea.Therewerealsodecreasesin
228 CAROLYN W. GREEN et al.
resistance and indices of unhappiness for Tami Results of observations conducted immedi-
during the enriched teaching program, with ately before and after the teaching sessions (i.e.,
respective averages of 11% (range, 6% to 17%) naturally occurring nondemand situations)
and 1% (range, 0% to 8%) relative to baseline suggested that the teaching occasioned indices
averages of 78% (range, 60% to 100%) and of unhappiness relative to the naturally occur-
19% (range, 0% to 67%). ring environmental situations of the partici-
Further examination of Figure 1 reveals that pants. Specifically, there were no observations
althoughthepercentageofintervalswithindices of indices of unhappiness prior to or after
ofunhappinesswasmostfrequentlyzeroduring teaching sessions (even when indices of un-
the enriched teaching sessions for each partic- happiness were frequent during baseline teach-
ipant,therewerenotasmanysessionswithzero ing sessions) throughout the study for Pam or
percentages of resistance. Because there usually Tami. Indices of unhappiness were also very
were more observation intervals during the infrequent for Bea during these periods,
averaging less than 4% of observation intervals
program condition than the baseline condition
throughout the study.
due to the increased length of the teaching
sessions(e.g.,whenbriefbreakswereconducted
Participant Responses to Teaching Sessions
following resistance), it was possible that
Duringbaseline,theaveragepromptlevelfor
although thepercentage of observation intervals
eachparticipanttocompleteherrespectivetask-
with resistance decreased during the enriched
analyzed steps wasbetweenhand-over-hand full
teaching, the absolute number of intervals with
physical guidance (Level 1) and partial physical
resistance may have remained the same relative
guidance at the wrist (Level 2), with specific
to baseline (i.e., in determining the percentage
prompt level averages of 1.3, 1.9, and 1.3 for
of intervals with resistance, the denominators
Pam, Bea, and Tami, respectively. Average
were larger during the program condition).
prompt levels during the enriched teaching
However, examination of the absolute number
program reflected no negative impact of the
ofintervalswithresistancedidnotindicatethis.
program on the participants’ responsiveness.
Although the average number of observation
During the program, Pam and Bea required an
intervals per teaching session during baseline
average prompt level between partial physical
was 9 (range of 4 to 24 across sessions and
guidance at the wrist (Level 2) and partial
participants) compared to 12 (range, 5 to 28)
guidance at the elbow (Level 3), with respective
during the enriched teaching, the total number
averagesof2.3and2.1.Duringfollow-up,Pam
ofintervalswithresistancestilldecreasedduring
showed more independence, in that she com-
the latter condition. The average number of pleted some steps in response to a verbal
observation intervals with resistance per teach- prompt (Level 4), with an overall level of 3.4,
ing session for Pam decreased from 2 (range, whereas Bea showed the same level of respon-
0 to 5) during baseline to 0.5 (range, 0 to 2) siveness as during theprogram condition.Tami
duringtheenrichedteachingcondition,withno continued to require an average prompt level
intervals with resistance during the last six during the enriched teaching program of be-
sessions and follow-up. Similar decreases oc- tween full physical guidance and partial guid-
curred for Bea and Tami, with respective ance at the wrist (average of 1.2).
baseline averages of 5 (range, 0 to 12) and 4
(range, 3 to 5) and averages during enriched Staff Teaching Proficiency
teachingof1.2(range,0to4)and1.3(range,1 During baseline, staff proficiency in carrying
to 2). During follow-up for Bea, there were no out the teaching programs averaged 71% for
intervals with resistance. Pam’sstaffteacher,64%forBea’sstaffteachers,
ENRICHED TEACHING FOR REDUCING RESISTANCE 229
and76%for Tami’s staff teacher.There wasno reported the new program was neither easier
indication of a negative impact of the enriched norharderthantheformerprogram(4),Tami’s
teaching program on teaching proficiency. Pro- reported that the new program was a whole lot
ficiency improved on average for Pam’s (91%) easier(7),andtheaverageforBea’steacherswas
and Tami’s (93%) teachers, and remained 5.5 (between a little easier and somewhat easier;
similar to thebaseline average for Bea’s teachers range,4to7).Finally,allteachersreportedthat
(67%). Because the improvement in teaching they would rather carry out the new teaching
proficiencymayhaverepresentedaconfounding program than the former program.
effect of the enriched teaching program, a more
refined analysis of changes in teaching pro-
DISCUSSION
ficiency was conducted. The analysis re-
vealed that increases were inconsistent from Results indicated that resistance and indices
session to session and there was considerable of unhappiness during teaching sessions de-
overlap in percentage of teaching skills imple- creased for the 3 participants with profound
mentedcorrectly between theenriched teaching multiple disabilities each time the enriched
conditionandbaselinewitheachparticipant.In teaching program was implemented. Staff
addition, improvements in teaching proficiency questionnaire responses provided a degree of
by Pam’s and Bea’s teachers did not occur social validation for the results. All teachers
immediately once the enriched teaching pro- reported that the participants disliked the
gram was implemented (i.e., within the first program carried out during baseline, whereas
three sessions), whereas there were immediate Pam’s and Tami’s teachers and 3 of Bea’s 4
decreases after implementation of enriched teachers reported that their participants liked
teaching in unhappiness indices for Pam and the program during the enriched teaching. All
Bea(Figure1)aswellasimmediatedecreasesin teacherslikewisereportedthatthenewprogram
resistance for Bea. Hence, these changes in increased participant enjoyment during teach-
indices of unhappiness and resistance occurred ing, and all reported that they preferred the
beforeanychangesinstaffteachingproficiency. enriched teaching condition. As indicated
earlier,staffperceptionsofenhancedenjoyment
Acceptability Measures among participants during teaching sessions
Results of the acceptability survey indicated may beneficially affect staff compliance in
that the staff teachers believed the original carrying out designated teaching procedures.
teaching program (baseline) was disliked by Finally, results indicated that there were no
each participant (Question 1). Pam’s and negative effects of the enriched teaching pro-
Tami’s teachers reported that their participants gramonparticipantresponsiveness(participants
disliked the program a whole lot (1 on the increased their relative independence slightly or
Likert scale), and the average for Bea’s staff maintained their existing level of independence
teachers was 2.3 (between disliked a little and during the enriched teaching condition) or staff
disliked some; range, 1 to 3). In contrast, Pam’s teaching proficiency.
and Tami’s teachers both reported that their The enriched teaching program was designed
participants liked the enriched program some as a package of procedures to enhance its
(6), and the average for Bea’s teachers was 5 probability of success (Bailey & Burch, 2002,
(likedalittlebit;range,3to7).Allteachersalso chap. 3) and potentially its likelihood of being
reported that the new program increased par- effective when applied by different staff with
ticipant enjoyment either some (6) or a whole a given participant (Progar et al., 2001). The
lot (7). Regarding the ease with which the two intent was to provide a straightforward ap-
programs were carried out, Pam’s teacher proach for working with people with profound
230 CAROLYN W. GREEN et al.
multiple disabilities who appear to dislike resistance during teaching, the risk of negative
various teaching programs: Select the most reinforcement exists. It may have been that
preferred activities provided in existing person- immediately following the break with a return
centered plans, provide samples of those to the teaching trial, such that the participant
activities before, during, and after a teaching did not avoid completing the trial, prevented
session and remove nonpreferred activities, and reinforcement of resistance (Green & Reid).
follow each instance of resistance with a brief Alternatively, it may have been that the
breakandapreferredactivitybeforecompleting preferred activitiesprovidedbeforeandpossibly
the ongoing teaching step. Although the during the teaching sessions functioned in an
packaged program was effective, a number of antecedent manner to lessen the aversive
questionsanddirectionsforfutureresearchexist properties of teaching and, correspondingly,
due to the different procedural components. participant motivation to resist or escape (Long
A primary question for future research et al., in press). Nevertheless, if a component
pertains to determining if all components of analysis revealed that the break contingency
the program are necessary for the program’s could be removed from the overall program
effectiveness. Identifying critical and noncritical without reducing its effectiveness, then the risk
componentswouldenhancetheeasewithwhich of possibly reinforcing resistance would be
the enriched teaching program could be imple- eliminated.
mented,providedtherobustnessoftheprogram Another issue with the enriched teaching
isnotcompromisedintermsofbeingeffectively program that warrants attention pertains to
carried out by routine support staff. In the relying on preferred activities identified in
present study, although all but 1 teacher person-centered plans in contrast to systematic
reported that the enriched teaching program preference assessments. Although there is some
was easier to carry out relative to the traditional empirical support for the accuracy of prefer-
teaching program (1 teacher reported no dif- ences identified through staff opinion that
ference), the new program consistently required forms the basis of the plans if the preferences
10 to 15 min longer to implement. Identifying are reported as favorites or very strong prefer-
noncritical program procedures may reduce the ences, there is also a risk involved in relying
time required to implement the enriched solely on staff opinion in terms of the accuracy
teaching process. of what is reported to be preferred (Reid,
One aspect of the program that warrants Everson, & Green, 1999). Such risk can be
particular attention in a component analysis heightened when more than the most preferred
is the break contingency for occurrence of one or two activities are drawn from the plans,
resistance. A primary rationale for the break as was the case in this study. The original plan
contingency was that because the teaching was to enhance the enriched teaching program
procedures typically required at least some with systematically identified preferences if the
physical prompting through manual guidance, firstapplicationswereineffective,butsuchsteps
the guidance may have been discomforting were not necessary. Nonetheless, particular
for the participants in light of their physical caution should be exercised along with careful
involvement (e.g., spasticity, contractures). The evaluation when selecting preferred activities
brief break may have lessened possible discom- based solely on staff opinion in person-centered
fort. However, as discussed by Green and Reid plans. Also, a direction for future research is to
(1999),suchacontingencycanimposeariskof evaluate means of making systematic preference
negatively reinforcing resistance. Even though assessments a more standard part of routine
there did not appear to be such an effect with service provision (cf. Lohrmann-O’Rourke,