Performance Feedback Procedures for Sleep Protocol

Background:   Asking adults in community settings to implement evidence-based intervention (EBI), is an intervention in itself. That is, in order for interventions to be disseminated in community settings, the behavior of the adults implementing the EBI requires change too. The standard approach to adult training includes didactic presentation which rarely results in the desired behavior change. More than 60 years of consultation studies and scientific publications illustrate that didactic training without ongoing consultation and feedback does not result in implementation fidelity at clinical levels. Performance feedback (PFB) consultation (Noell et al., 2005; Connell, 2010) is a set of procedures that provides the important transfer of knowledge, andemphasizes implementation adherence through the use of modeling, practice and feedback.  This project is novel in that performance feedback procedures will be implemented in the home, where the primary intervention agent is the parent and the intervention procedures are designed to reduce night-time awakenings and insomnia  using either a Tailored Behavioral Intervention or the Standard Care protocol.

Objectives:

(1)    Describe positive routines and PFB procedures

(2)    Discuss the challenges of training a multidisciplinary team to provide PFB to caregivers of children with ASD and insomnia implementing a TAB.

(3)    Describe the strengths and limitations of a multidisciplinary team implementing PFB with the caregivers

 Methods:

Performance feedback is a set of procedures that includes frequent consultative support about plan implementation using detailed and frequent consultative visits. Fidelity will be measured by the percentage of total number of steps completed by caregivers (s), divided by the steps in the TAB at each visit. 

The 3 components of the TAB: positive routines, faded bedtime protocol and 12 activities in a Calming Module, all have specific sequenced steps to follow. Caregivers and consultant will develop a tailored plan and goals will be agreed upon. During each subsequent visit, the steps completed for each agreed upon activity will be reviewed and visually graphed and discussed with the caregiver. Feedback will be clear, focus on missed steps and overcoming barriers to implementation and have a graph to show the percent of completed steps for review and discussion. New goals may need to be negotiated depending on the barriers uncovered during the consultation, and the caregiver’s ability to overcome those barriers.

Results:   PFB consultation provides important transfer of knowledge, andemphasizes implementation adherence and fidelity through the use of modeling and implementation feedback to the consultee and caregiver. 

Conclusions:   We will present TAB implementation adherence for three participants before (baseline), and after (intervention) performance feedback is delivered using a within-subject, multiple baseline. The data will illustrate the effects of focused and tailored consultative procedures used in the home with the primary caregiver on the implementation of the TAB protocol.