The Impact of Online Training on Staff Knowledge and Training Efficiency

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1 + The Impact of Online Training on Staff Knowledge and Training Efficiency Conquering the cliff april 14 th, 2016 Megan Robinson Joy, Ph.D.. T R A I N I N G E F F I C I E N C Y

2 + Objectives Today we will discuss: the components of an effective training program the advantages of online instruction the benefits of including online instruction in a comprehensive training program how to systematically evaluate your training program Special thanks to contributors to this project: Melanie Dubard, Ph.D., BCBA-D and Robert Putnam, Ph.D., BCBA-D

3 + Who we are The May Institute is a large behavioral health organization serving over 6,000 individuals with autism, developmental disabilities, intellectual disabilities, neurological disorders, behavior disorders and mental illness across the country. We provide: Adult services Children s educational services Residential services Home and community services Outpatient therapy Evaluation and diagnostic services

4 + Our mission We are committed to excellence in specialized services through training, research, and the highest level of professional expertise to meet the broad range of needs in individuals, families schools and communities. We provide evidence-based interventions to improve quality of life outcomes for the people we serve. For individuals with autism, interventions are based on the foundations of applied behavior analysis.

5 + Increasing need for people to be trained in autism and ABA Surveillance data from the CDC indicates that 1 in 68 children has a diagnosis of an autism spectrum disorder. Children are being diagnosed at younger ages, increasing early access to services. In MA, An Act Related to Insurance Coverage (ARICA) was enacted in 2010, requiring private insurance to cover therapy for children with autism. In 2015 MassHealth also began to cover ABA services.

6 + How we think about training Positive Behavior Interventions and Support (PBIS) Framework PBIS is a framework for systematic problem solving using a tiered, prevention-based approach and empirically-based practices to enhance outcomes for all individuals

7 + 3-TIER LOGIC: EMPHASIS ON PREVENTION Primary Provide foundation training for all employees Secondary Tertiary Provide additional training for employees who require more support Provide intensive focused training for employees who do not meet identified standards

8 FEW More ~1-5% SOME ~10-15% Less ALL ~80-90%

9 4 PBIS Elements OUTCOMES Supporting Staff Behavior Supporting Decision Making PRACTICES Supporting Effective Training

10 Primary Training: Orientation to agency First Aid/CPR Safety Care Division policy and procedure Training on Applied Behavior Analysis (ABA)

11 + What would primary training in your agency look like How to use technology systems? Benefits? Health and safety? Where is the best place to order lunch?

12 4 PBIS Elements OUTCOMES Supporting Staff Behavior Supporting Decision Making PRACTICES Supporting Effective Training

13 + What constitutes a good training program? Effective training program consists of: Didactic Instruction Written Verbal Demonstration Modeling Video Modeling Hands on Training Role Play Feedback In Vivo Coaching Feedback Kazdin, 2001; Reid & Parsons, 2002

14 + What constitutes a good training program? The BACB recently released guidelines for credentialing behavior technicians (paraprofessionals who provide direct service based on the principles of ABA) Training should consist of at least 40 hours of instruction on the principles of ABA, including measurement, assessment, skill acquisition, behavior reduction, documentation & reporting, ethics and professional conduct. Training may be didactic, experiential, or a combination

15 + Difficulties developing effective and efficient training programs (1) Distal centers throughout the country (1) Difficulty standardizing training, ensuring consistency (2) Different programs and centers may have different needs

16 + Service locations

17 + Difficulties developing effective and efficient training programs (2) Episodic hiring (1) Staff are trained in groups of 1-3 people at a time (2) Training can be time consuming (3) Difficulty standardizing even within the same trainer

18 + Difficulties developing effective and efficient training programs (3) Didactic training conducted by senior clinicians, BCBAs and Ph.D.s, competes with other responsibilities, such as supervision and billable clinical activities Drain on resources: (1) time and (2) money Five hours of didactic instruction can cost up to $750 in lost revenue.

19 + Online instruction Online training can systematize instruction. Online instruction can easily incorporate testing, which is considered an important component of didactic instruction (Kadzin, 2001) Online instruction can utilize video modeling, which has an extensive research base. Possible to use a blended approach, with didactic instruction and demonstration through online training, role play, coaching and feedback through in person training

20 + Data on online instruction 1,000 empirical studies on online learning since 1996 A recent meta-analysis of online learning studies found that students receiving online instruction performed better than those receiving face-to-face in service training (Means, et al., 2009). Wiech (2014) demonstrated that online training can be used to improve fidelity to mand training procedures and online training plus coaching & feedback improved spontaneous mands among students

21 + Why we chose relias learning Approved by the Behavior Analyst Certification Board (BACB) for continuing education credits Aligned with the National Autism Center s (NAC) National Standards Project Training sequence can be customized for each program Modules include pre and post-tests to assess comprehension.

22 + Evaluating effectiveness of online training Compared test results following training with Online Learning modules for new staff. Sample included: (1) Teacher aides working in ABA-based school (2) Direct care staff working in a residential program (3) Direct therapists working in homes and public schools Training modules were customized to the needs of the program.

23 + Online training Data for School and Residential staff 100 Average Pre/Post Scores on ATS Modules Pre Post Pre Post Pre Post Pre Post Intro to ASD Principle of Behavior: Reinforcement Principles of Behavior: Behavior Reduction Teaching New Behavior

24 + Online training data for home and school direct therapists

25 + Online training data for home and school direct therapists

26 + Evaluation of effectiveness with an outside measure The Knowledge of Behavioral Principles As Applied to Children (KBPAC) instrument is a 50-item multiple forced-choice test designed to assess understanding of the application of basic behavioral principles to children (O Dell, 1979). New staff were administered the KBPAC prior to starting training. Staff then received training in two groups: (1) Relias Learning Modules (2) Live training

27 + KBPAC test scores for school and residential staff 100 Average Pre/Post KBPAC Scores Percentage of Items Answered Correctly Pre-test Score Live Training ATS Post-test Score

28 + kbpac test scores for residential staff Percentage of Items Answered Correctly Average Pre/Post KBPAC Scores Pre-test Scores Post-test Scores Live Training-Res ATS-Res

29 + Examining acquisition of core concepts for direct therapists Examined test data for two areas considered fundamental to teaching new skills (1) Discrete trial training: identify components of DT, correct ways to deliver SD, prompt, feedback, shaping and chaining procedures, reinforcement, mastery, generalization (2) Instructional control: motivation, reinforcement, errorless teaching, mixed and varied task presentation

30 + Examining acquisition of core concepts for direct therapists Compared scores on post-test for two groups (1) TAU: Training as Usual: Staff completed typical training protocol, included at least 4 hours of didactic training and 40 hours of in vivo training in the field. (2) TAU + Online instruction: Staff completed TAU plus at least 10 hours of online training, including modules on instructional control and DTT.

31 + Comparing Training as usual to training as usual plus Relias 100 Post-Test Scores for Instructional Control and DTT TAU TAU + ATS Instructional Control DTT

32 + Conclusions: Effectiveness Pre and post tests scores from the training modules showed that staff performed higher on the post-test across all modules within all training programs Results from KBPAC scores showed that online training was as effective as live training for acquisition of basic behavioral principles Comparison data from direct therapists shows that staff who participated in online training acquired more knowledge in the area of DTT and instructional control than staff who participated in the typical training program

33 + Conclusions: Efficiency Through online training, hours of didactic instruction was provided without direct intervention from a supervisor If supervisors were pulled from the field to provide that training, it would have resulted in up to $2,000 in lost revenue per training for direct therapists. Training programs were able to be standardized across training centers.

34 + Conclusions Online Learning online modules allow trainers to make data-based decisions regarding training Trainers can monitor staff scores and errors through the training sequence. Trainers can assess the appropriateness of selected training modules for their program. - Intro to Autism modules for direct therapists may be eliminated based on high average pre-test scores

35 4 PBIS Elements OUTCOMES Supporting Staff Behavior Supporting Decision Making PRACTICES Supporting Effective Training

36 + Conclusions Following online training, staff should participate in experiences for hands-on training, with in vivo coaching and feedback. Opportunities for mentorship Online training may be combined with experiential training opportunities to create an effective training program

37 + Comprehensive training program Online training as defined by the center Didactic and modeling experiences In vivo observation and practice Observation, role play and feedback by experts Evaluation of competencies on core skills Online instruction = written evaluation Supervisors assess demonstration of skills Use of data to determine if more intensive training is needed

38 + Comprehensive training program Following online instruction and in vivo training, new staff are assessed with the BACB competency assessment for an registered behavior technician (RBT) credential. More individualized treatment integrity checklists may be used as stepping stones to the RBT assessment.

39 Tertiary Training: Formalized plan for improving skills in areas of weakness Secondary Training: Additional Relias training modules Peer mentors for observation and feedback Regular meetings with supervisor to review progress Primary Training: Training on Applied Behavior Analysis: Relias Core Curriculum

40 + Developing a training program Identify core skills needed for staff to perform well at their job Can instruction in these areas be addressed through online instruction? Identify competencies needed to be demonstrated by staff to be successful Training needed to address these skills for all staff are your Primary Training Interventions

41 + Developing a training program How will staff be assessed in these core skills? What if staff do not perform core skills with competency? What additional supports can be put into place to enhance training? These are your Secondary Training Interventions How will you address staff who do not respond to secondary interventions? These are your Tertiary Interventions

42 4 PBIS Elements OUTCOMES Supporting Staff Behavior Supporting Decision Making PRACTICES Supporting Effective Training

43 + Systems of support What systems are needed to support your training program? Access to technology Dedicated staff for training Dedicated staff for setting up and supporting online instruction Time to analyze staff performance

44 + Evaluating your training program Develop a new training program and compare it to training as usual. Identify how you want to assess knowledge and demonstration of skills Written tests and evaluations by supervisors Examine other measures that target resources needed for training: time, cost, staffing levels

45 + Questions? For questions and comments, please Megan Robinson Joy Thank you!

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