ERIC EJ750855: Training Student Teachers to Reposition Infants Frequently

2006·0.26 MB·English

by  ERIC

JOURNALOFAPPLIEDBEHAVIORANALYSIS 2006, 39, 489–494 NUMBER4 (WINTER2006)
TRAINING STUDENT TEACHERS TO REPOSITION
INFANTS FREQUENTLY
NICOLE M. COTNOIR-BICHELMAN, RACHEL H. THOMPSON,
PAIGE M. MCKERCHAR, AND JESSICA L. HAREMZA
UNIVERSITYOFKANSAS
We evaluated the effects of an intervention designed to increase the variety of positions
experienced by infants in a child-care setting. Six student teachers were trained, using
amulticomponentintervention,torepositioninfantsaccordingtoachart.Theinterventionwas
successful inincreasing the meanpercentage ofcorrect position changes madebyall6student
teachers, and performance gains by 3 student teachers persisted when supervisor feedback was
briefly removed.
DESCRIPTORS: flattenedhead,feedback,infantpositioning,self-recording,teachertraining
_______________________________________________________________________________
Since 1992, the American Academy of A large percentage of infants are enrolled in
Pediatrics (AAP) has recommended that infants child care; therefore, we evaluated the effects of
beplaced on their backstosleep to decreasethe a chart and supervisor feedback to train student
risk of sudden infant death syndrome (SIDS) teachers in an infant classroom to track each
(AAP, 1992). This campaign has been associ- infant’s daily history of positions and to re-
ated with a decrease in SIDS, but it is also position the infants accordingly. Our procedures
correlated with an increase in posterior plagio- weresimilartothoseusedbyKunzetal.(1982).
cephaly (i.e., flattened back of the head),
a condition that affects an estimated 1 in 60
METHOD
children (Biggs, 2003). Treatment often in-
Setting
volves the use of cranial remolding orthoses,
Observations were conducted in a university-
which are costly and draw negative attention to
run infant classroom that was partitioned into
thechildren.Ifleftuntreated,thisconditioncan
several different zones designed to accommo-
cause mild developmental disabilities. In addi-
date specific activities (e.g., feeding, napping,
tion, there is some evidence that children who
and play). Student teachers were assigned to
sleep on their backs acquire motor skills later
zones (LeLaurin & Risley, 1972) according to
than other children (Davis, Moon, Sachs, &
a 30-min rotating schedule, resulting in each
Ottolini, 1998; Ratliff-Schaub et al., 2001). To
student teacher being assigned to the play area
offset the negative side effects associated with
twice on each 4-hr shift. The play area
supine sleeping, experts recommend placing
contained two play mats on opposite sides of
children in a variety of positions when awake
the room on which student teachers conducted
(Mahoney, 2003).
play activities. One play activity (e.g., rattles,
puppets) was conducted at a time, and student
Thisresearchisbasedonathesissubmittedbythefirst
author in partial fulfillment of requirements for the teachers changed play activities every 15 min.
master’s degree. We thank Gregory Hanley and R. Mark At this time, student teachers initiated a new
Mathewsfor their commentson anearlierversion ofthis
activity on the unoccupied play mat and were
manuscript.
Address correspondence to Rachel Thompson, De- expectedtochangethepositionsofallimmobile
partment of Applied Behavioral Science, 1000 Sunnyside infants as they transitioned to the activity.
Ave., University of Kansas, Lawrence, Kansas 66045 (e-
At any given point, 9 infants, who ranged in
mail:[email protected]).
doi:10.1901/jaba.2006.9-06 age from 2 to 17 months, were enrolled in the
489
490 NICOLE M. COTNOIR-BICHELMAN et al.
program. Over the course of the study, 11 duringactivitytransitions,whichoccurredevery
infants who could not independently change 15 min. The observation interval began when
their own positions (e.g., pull themselves to the student teacher stood upto retrieve the new
asittingposition)atthestartofeachphasewere play activity and ended1 min after all children,
targeted for intervention. Data collection was mobile and immobile, had been moved to the
discontinued for individual participants when new play area. Therefore, the length of each
those infants became able to change their own observation varied, but was never longer than
positions. Ten infants were typically develop- 5 min. Observers recorded the name of the
ing, and 1 had Down syndrome. The number infant,thenewpositioninwhichtheinfantwas
of children present in the play zone varied from placed, and the name of the student teacher
1 to 9. who placed the infant into that position.
Five positions were considered appropriate
Participants
for all of the infants: side, stomach, back,
Six undergraduate students who were en-
assisted sitting, and assisted standing. These
rolled in a practicum course in early education
positions were targeted because each provided
and intervention participated. Each student
the infants with an opportunity to practice an
teacher was assigned to the morning shift
important motor skill (e.g., rolling, crawling).
(7:30 a.m. to 11:30 a.m.), either during the
The new position was scored 1 s after both of
fall or summer semester, on which she worked
the student teacher’s hands were removed from
with 2 other student teachers and a graduate
the child’s body. Data collectors recorded back
student supervisor. Prior to the study, student
whenaninfantwasplacedinareclinedposition
teachers participated in a 1-day orientation
(i.e.,torsoandlegsformedananglegreaterthan
during which they received written and vocal
90u), stomach when the infant’s stomach was in
instruction on classroom procedures. During
contactwiththefloor,sidewhentheinfant’sleft
orientation, teachers were instructed to change
or right arm and leg were in contact with the
the positions of the infants when a new toy was
floor bearing weight, assisted sitting when the
presented (i.e., every 15 min), and examples of
infant was supported with his or her torso
appropriate positioning strategies were de-
elevated and torso and legs formed a 90u angle,
scribed and modeled.
and assisted standing when the infant was
Data Collection and Interobserver Agreement partially supported with feet touching the floor
Trained graduate and undergraduate obser- and bearing weight. For 1 participant, Heather,
vers recorded data from behind a one-way the knees position was included on the
mirror or behind a barrier on the outskirts of recommendation of a physical therapist. Knees
the classroom, during the typical classroom was recorded when Heather’s knees were
routine. Student teachers were aware that they touching the floor with her body in an upright
were participating in a study to increase the position.
variety of positions infants experienced but did The goal of the intervention was for each
not know exactly when they were being child to experience the full range of appropriate
observed. positions before experiencing duplicate posi-
Student teachers were observed between 8:15 tions (i.e., a position already experienced on
a.m. and 10:15 a.m. This period was selected that day). Therefore, a position change was
because several infants were typically present in considered correct if the child had never
the classroom and the 3 participating student experienced the particular position that day, or
teachers were primarily responsible for con- had already received all appropriate positions
ducting play activities. Data were recorded beforebeingplacedinaduplicateposition.The
INFANT POSITIONING 491
percentage of correct position changes made by (range,33%to100%),and94%(range,70%to
each student teacher was calculated by dividing 100%) for the child’s position, student teacher
the number of correct position changes by the name,andcorrectchartuse,respectively.During
number of positioning opportunities and mul- thesummersemester,agreementwas97%(range,
tiplying by 100%. Percentage of correct 50% to 100%), 97% (range,0%to 100%), and
position changes was chosen as the primary 97% (range, 75% to 100%) for the child’s
dependent variable because it was appropriate position,studentteachername,andcorrectchart
for baseline conditions (when no one position use, respectively. Agreement was strongly influ-
was considered correct) and for those in which enced bythe number of observationintervals.In
a chart specified the appropriate condition. some instances, low agreement scores were
Inaddition,duringthechart-plus-supervisor- obtained when only a small number of observa-
feedbackandthechart-without-supervisor-feed- tion intervals were recorded on a given day.
back conditions, observers recorded whether or
Procedure
notthestudentteachersusedthechartcorrectly.
Baseline. A sheet of paper (22 cm by 28 cm)
Thepercentageofcorrectchartcompletionswas
listing recommended positions was posted in
calculated by dividing the number of times the
the classroom. Student teachers were also
student teachers used the chart correctly by the
reminded, approximately once per week (in-
number of opportunities to use the chart and
dependent of performance), to change the
multiplying by 100%. Correct chart use was
infants’ positions every 15 min.
recorded when the student teacher placed the
Chart plus supervisor feedback. During a staff
childintothepositionlistedonthechartforthe
meeting held prior to the student teachers’ first
given interval and, within 1 min of moving all
opportunity to use the chart, student teachers
children to the play activity, indicated that the
were shown pictures illustrating appropriate
positionhadbeenusedby(a)placing anXover
positions for each of the five categories listed
the position listed on the chart for the given
above. Also, a dry-erase board (85 cm by
interval (fall) or (b) removing the appropriate
56 cm) that listed the names of each infant
hook-and-loop card from the chart and placing
and specified an individualized order of posi-
it in an envelope located next to the chart
tions was placed in a highly visible area of the
(summer).
classroom. Using this chart, student teachers
A second observer simultaneously but in- were instructed to locate the appropriate
dependently collected data for a minimum of position for each child, place the child into
30% of intervals for both semesters. Interob- the position, and self-record the use of that
server agreement was calculated by dividing the position by placing an X over the position (fall)
totalnumberofagreementsbythetotalnumber or removing the hook-and-loop card that listed
of agreements plus the total number of the position (summer). Recording of positions
disagreements and multiplying by 100%. An was to occur within 1 min of moving all of the
agreement was scored when both observers children to the new activity. When chart plus
recorded the same information for each catego- supervisorfeedbackwasreinstatedfollowingthe
ry during a particular observation interval. A return to baseline, these instructions were
disagreement was scored when observers scored repeated in an abbreviated format (e.g., with
different information for a category or when fewer examples) just prior to the student
one observer failed to record any information teachers’ next opportunity to reposition the
for a particular category. infants. At the end of each shift, the classroom
During the fall semester, interobserver agree- supervisor met with the 3 student teachers as
ment was 95% (range, 62% to 100%), 91% a group and provided feedback indicating how
492 NICOLE M. COTNOIR-BICHELMAN et al.
Figure 1. The mean percentage of correct position changes and mean number of positioning opportunities for
Teachers1,2,and3duringbaselineandchartplussupervisorfeedback(top).Themeanpercentageofcorrectposition
changesandmeannumberofpositioningopportunitiesforTeachers4,5,and6duringbaseline,chartplussupervisor
feedback, andchartwithout supervisor feedback(bottom).
many times they changed the position of each Chart without supervisor feedback. As in chart
infant, the number of positions in which they plus supervisor feedback, the chart was hung in
placed each infant, and the number of oppor- theclassroomtoallowteacherstotrackandself-
tunities on which they failed to reposition each record position changes. A picture book with
infant correctly. examples of each position was also posted;
INFANT POSITIONING 493
Table 1
Resultsfor Individual Student Teachers
Meanpercentagecorrectpositionchanges
Numberof Chartplus Chartplus Chartwithout
Studentteacher opportunities Baseline supervisorfeedback Baseline supervisorfeedback supervisorfeedback
1 249 52 93 75 100
2 234 62 92 80 91
3 204 72 94 73 99
4 120 43 87 43 100 93
5 167 57 79 54 96 100
6 124 49 96 72 94 97
however, no supervisor feedback was provided 85% to 100%) chart-plus-supervisor-feedback
regarding infant positioning. conditions compared with the first (M 5 54%,
range, 31% to 100%) and second (M 5 54%,
range, 31% to 64%) baseline conditions. In
RESULTS AND DISCUSSION
addition, this improved performance persisted
The top panel of Figure 1 depicts data from (M596%,range,93%to100%)for5 daysin
Teachers 1, 2, and 3, who participated during the absence of supervisor feedback. Mean
the fall semester. During baseline, student percentage of correct chart use was 83%(range,
teacher performance was variable (M 5 63%, 75% to 93%) and 80% (range, 61% to 100%)
range, 31% to 86%). When chart plus in the first and second phases of the chart-
supervisorfeedbackwasimplemented,themean plus-supervisor-feedback condition, respectively.
percentageofcorrectpositionchangesincreased During chart without supervisor feedback, the
(M 5 93%, range,5 84% to 100%). Perfor- mean percentage of correct chart completion
mancewasdisrupted(M577%,range,50%to was 94% (range, 90% to 100%).
100%) during the reversal to baseline, and Results for individual teachers are presented
when chart plus supervisor feedback was again in Table 1. The chart plus supervisor feedback
implemented, the mean percentage of correct resulted in an increase in the mean percentage
positioning increased to high levels (M5 94%, of correct position changes for each student
range, 81% to 100%) relative to baseline, and teacher.Inaddition,thisimprovedperformance
this improvement was maintained for the persisted when supervisor feedback was with-
duration of the study. The mean percentage of drawn for Teachers 4, 5, and 6.
correct chart use for these teachers was 93% The chart plus supervisor feedback increased
(range,84%to100%)and92%(range,75%to mean correct position changes made by all 6
100%) for the first and second chart-plus- student teachers. Our results replicate those of
supervisor-feedback conditions, respectively. Kunzetal.(1982),whouseddiaperingandplay
The bottom panel of Figure 1 depicts data charts with supervisor feedback to improve
for Teachers 4, 5, and 6, who participated performance of infant caregivers. In addition,
during the summer semester. The results of the our findings replicate a large body of existing
first four phases replicate those obtained during research that demonstrates the effects of
the fall semester. The mean percentage of multicomponent, behaviorally based staff-train-
correct position changes was substantially ing programs (e.g., Austin, Weatherly, &
higher during the first (M 5 91%, range, Gravina, 2005; Burg, Reid, & Lattimore,
75% to 100%) and second (M 5 94%, range, 1979; Burgio et al., 1990; Richman, Riordan,
494 NICOLE M. COTNOIR-BICHELMAN et al.
Reiss, Pyles, & Bailey, 1988). Our study Biggs, W. S. (2003). Diagnosis and management of
positionalheaddeformity.AmericanFamilyPhysician,
extends this research by applying similar
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methods to address a socially important but
Burg,M.M.,Reid,D.H.,&Lattimore,J.(1979).Useof
often overlooked problem, infant repositioning. a self-recording and supervision program to change
Our intervention consisted of a number of institutional staff behavior. Journal of Applied Behav-
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potentially influential components including
Burgio,L.D.,Engel,B.T.,Hawkins,A.,McCormick,K.,
vocalinstruction,publiclypostedwritteninstruc- Scheve, A., & Jones, L. T. (1990). A staff
tions, visual prompts, self-recording, and super- management system for maintaining improvements
in continence with elderly nursing home residents.
visor feedback, and the design of the study did
JournalofAppliedBehavior Analysis, 23,111–118.
notallowtheisolationoftheeffectsofindividual
Davis,B.E.,Moon,R.Y.,Sachs,H.C.,&Ottolini,M.
components. We attempted to reduce the effort C. (1998). Effects of sleep position on infant motor
associated with the intervention by withdrawing development. Pediatrics,102,1135–1143.
Kunz,G.G.R.,Lutzker,J.R.,Cuvo,A.J.,Eddleman,J.,
the most labor-intensive component, the super-
Lutzker, S. Z., & Megson, D., et al. (1982).
visor feedback, and found that improved perfor- Evaluating strategies to improve careprovider perfor-
mance by Teachers 4, 5, and 6 persisted during manceonhealthanddevelopmentaltasksinaninfant
a brief (5-day) period without supervisor feed- care facility. Journal of Applied Behavior Analysis, 15,
521–531.
back.Theseresultssuggestthat,afterexposureto
LeLaurin,K.,&Risley,T.R.(1972).Theorganizationof
the chart plus supervisor feedback, performance day-careenvironments:‘‘Zone’’versus‘‘man-to-man’’
gainsmaybemaintainedwithareducedschedule staffassignments.JournalofAppliedBehaviorAnalysis,
5,225–232.
of supervisor feedback, or even in the absence of
Mahoney,D.(2003).Infants’positionalskulldeformities
supervisorfeedback.However,thechart-without-
easily managed: Rise linked to sleeping on backs.
supervisor-feedback phase was too brief to draw FamilyPractice News,3,68.
firm conclusions regarding the necessity of Ratliff-Schaub,K.,Hunt,C.E.,Crowell,D.,Golub,H.,
Smok-Pearsall, S., & Palmer, P., et al. (2001).
supervisor feedback.
Relationshipbetweeninfantsleeppositionandmotor
developmentinpreterminfants.JournalofBehavioral
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