W. Larry Williams

Overview of the treatment of rumination disorder for adults in a residential setting

Rumination, or the chewing and re-swallowing of regurgitated stomach contents, can be found in up to 10% of institutionalized individuals with severe or profound mental retardation. Serious physical consequences, including death, can result from the disorder. Unfortunately, rumination can be subtle and difficult to observe and often continues untreated. Additionally, the research literature has provided divergent results without clear treatment guidance for clinicians. We present an overview of the history of rumination, a review of the literature on its etiology and treatment, and recommendations for future research.

Comparison of computer based instruction to behavior skills training for teaching staff implementation of discrete-trial instruction with an adult with autism.

In the current study, behavior skills training (BST) is compared to a computer based training package for teaching discrete trial instruction to staff, teaching an adult with autism. The computer based training package consisted of instructions, video modeling and feedback. BST consisted of instructions, modeling, rehearsal and feedback. Following training, participants were evaluated in terms of their accuracy on completing critical skills for running a discrete trial program. Six participants completed training; three received behavior skills training and three received the computer based training. Participants in the BST group performed better overall after training and during six week probes than those in the computer based training group. There were differences across both groups between research assistant and natural environment competency levels.

Component evaluation of a computer based format for teaching discrete trial and backward chaining

The effectiveness of a multi-component computer based training package that consisted of competency based instructions, video modeling, and two forms of feedback was evaluated in terms of treatment integrity of two procedures across four staff. Treatment integrity in completing critical steps of discrete-trial and backward chaining procedures were measured using a multiple baseline design across participants, counterbalanced for procedures. All four participants reached 100% treatment integrity on at least one skill in a role play setting. Maintenance probes showed skills maintained at the same levels 6 weeks following training.

A Description and Extension of a Human Services Management Model

Abstract A simple and yet powerful method for increasing the quantity and quality of service outcomes in organizations that provide such services for persons with developmental disabilities involves systematic and regular review of individual consumer related activity occurrences and outcome summaries at the middle and senior management levels (Williams & Cummings, 2001). Once established, and with some level of inter-observer agreement, this practice has been shown to result in significant increases in the amount and effectiveness of direct service related activities while simultaneously establishing an organizational level baseline measure against which almost any management, supervisory, or staff training intervention can be evaluated. This paper describes two further applications of this general procedure in a large midwestern community service provider. One application increased accuracy of service related documentation procedures and actual services and outcomes in six community ICF/MR residential facilities. The second application in a multi-disciplinary team produced increases in services and outcomes across residential and day programs. These results extend previous reported effects of service review and are discussed in this light with a delineation of further needed research.

The Effects of Evaluating Video Examples of Staffs' Own versus Others' Performance on Discrete-Trial Training Skills in a Human Service Setting.

Many studies have been conducted evaluating the use of feedback in staff training in organizational settings. Central to this literature has been the use of a variety of forms of feedback, including videotaped feedback. A distinction is outlined between video modeling and a variety of possible video feedback procedures. Previous studies have indicated a possible positive training effect on staff skills from simply being exposed to relevant videotaped performances of those skills or as a result of evaluating video modeled performances. This study evaluated the effectiveness for training teaching skills of having staff evaluate videotaped teaching skills as performed by themselves versus others. The current study results replicate earlier research on the effectiveness of evaluating video models as a training method and do not suggest a difference between observing oneself as opposed to observing someone else. Future research suggestions for the general use of video in training are provided.

Evaluation of the Service Review Model With Performance Scorecards

The current study combined a management technique termed “Service Review” with performance scorecards to enhance staff and consumer behavior in a human service setting consisting of 11 supervisors and 56 front-line staff working with 9 adult consumers with challenging behaviors. Results of our intervention showed that service review and scorecards produced significant staff behavior changes that were maintained over time. Positive consumer outcomes were also correlated with staff performance changes. The behavioral package of training, clinical consultation, service review, biweekly manager meetings, scorecards, and public posting has the potential to reduce the need for monetary staff incentives.

Encopresis and Enuresis

Publisher Summary Two of the most common presenting complaints in primary medical care for children involve disordered elimination, specifically enuresis (urine) and encopresis (feces). Multiple physiological factors are associated with them, the most important of which are colonic motility, constipation, and fecal retention. Encopresis were earlier viewed as a problem in the character or personality of the individual, and thus it was common to treat the condition with social disapproval or even more extreme forms of punishment. Although, there have been a wide number and variety of strictly behaviorally oriented treatments for these diseases; the current bio-behavioral treatments focus on immediate medical assessment and treatment of the condition. There has been a proliferation of behaviorally oriented studies concerning nocturnal enuresis and to a lesser extent diurnal enuresis, which are not explicitly based on functional assessment or analysis. A behavioral analysis of the processes involved in encopresis addresses the role of physiological activity in the normal functioning of the colon, rectum, and associated smooth muscles and sphincters.

Examining the Effects of a Low-Cost Prompt to Reduce Retail Theft.

The present study evaluated the extent to which a low-cost, antitheft intervention impacted theft and sales in a multiple baseline design across two grocery stores. Previous research has measured the impact on theft of items that have a sign indicating their high theft rate and stickers next to or on the items. In contrast, this study tracked four intervention groups: a group directly marked with a sign and ribbons, two indirectly targeted groups (sign-only and a group down the aisle from the sign-only), and a group with no intervention. Results indicated the largest decrease in theft for one of the indirectly targeted groups, from 45 total items stolen to 13, compared to a smaller decrease in theft (i.e., 64 to 40) for the directly targeted sign and ribbons products. Implications of these findings for applying behavior-based antitheft interventions in retail businesses are discussed and future research is proposed.

An Evaluation of the Effects of Very Difficult Goals

ABSTRACT In 1968 the first cohesive theory on goal setting proposed that difficult goals produce higher levels of performance than easy goals and that specific goals produce a higher level of performance than “do your best” goals. While over 40 years of research supports this theory, there has been some discrepancy regarding the use of very difficult goals. This study was designed to examine the effects on performance of different levels of performance improvement goals and two different types of feedback, as feedback is often used in conjunction with goal setting. A group design was used with participants receiving one of two goal levels, and two different types of feedback. While no significant effects were found between the two types of feedback, goal level produced significant results in terms of performance and accuracy.

Methodological refinements in the behavior-analytic study of distraction: A preliminary investigation

ABSTRACT Traditional approaches to the study of distraction have involved evaluations of the effect of a stimulus on specific task performance, but without a conceptual analysis of how the stimulus might actually interfere with the specific task. In the present study, we evaluated the potentially distracting effects of various classes of stimuli that were related to the task in different ways. We found that moderate-intensity stimuli that were topographically similar or were members of an equivalence class that included similar stimuli to the task (i.e., the discriminative stimulus and the target behavior) had the greatest distracting effects, high-intensity stimuli that were dissimilar had minor distracting effects and low-intensity stimuli that were dissimilar had negligible distracting effects.