Extending the Reach of Behavior Analytic Intervention to India: A Preliminary Investigation of a Training Manual for Teaching Behavioral Skills to Parents and Service Providers

Background:

For decades, addressing the challenging behavior of individuals with developmental disabilities has involved a functional approach. Interventions such as functional analyses, differential reinforcement and non-contingent reinforcement have been replicated, extended and discussed across hundreds of studies. However, most research on these procedures, their efficacy, and their adoption has been developed and conducted in North American settings. To maximize the outcomes and generality of these practices across populations research must be conducted cross-culturally and cross-linguistically.

Objectives: The present study sought to replicate and extend functional assessment training procedures in a few key ways. First, we assessed our training procedures with an Indian population of parents and professionals including lower-resourced families that often experience barriers to participation in research. Second, we included clear descriptions of the cultural adaptations made to the training program including those involving language, the trainer, the structure, and content of delivery. Specifically, the purpose of the present study was to examine the effects of face-to-face training and the function based behavioral assessment and interventions (FBAI) manual on teaching behavior analytic perspectives and skills used to assess and treat problem behavior.

Methods:

We employed a waitlist control group using a quasi-experimental cross-over design to establish repeated measures and replicate the effect of the intervention across two groups. Forty-six individuals (including parents of children with disabilities and professionals involved with such children) participated in the study and were allocated either to an immediate treatment (n=22) or a waitlist control (n=24) group. We evaluated the outcomes directly targeted by the content of the manual (knowledge test), surveyed the participants’ self-reported use of specific evidence-based strategies (Participant Approach to Function based Intervention – Survey; PAFIS), and assessed the social validity of the training procedure.

Results: No significant differences (p = 0.29) were found between the groups in the pre-training knowledge test and PAFIS administration using an independent samples t-test. A significant difference in the increase in scores obtained in the pre-training and post-training knowledge test (p<0.0001) and PAFIS (p<0.0001) was found in both groups. In the social validity survey conducted after the training, all participants either agreed or strongly agreed that the training was an acceptable way to acquire the skills necessary to address problem behavior.

Conclusions:

The results obtained replicated those of prior studies that have shown that the education of parents and service providers is an effective way to support the management of problem behavior in children with a developmental disability. In regions such as India, where unsubstantiated treatments are often practiced, and several barriers exist to accessing behavior analytic intervention, the present study produced successful outcomes in the education and training of parents and service providers. Although the training produced positive outcomes, more support is likely needed to maintain impactful outcomes at high integrity, over time. An outreach strategy for international dissemination will likely be most successful in collaboration with a culturally-responsive training program like the one described herein.