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This study aimed to evaluate how performance variability contributes to perioperative sentinel events occurring within the Dutch healthcare system. Although performance variability was identified as a contributing factor in almost all analysis reports, it remains unrecognized by the sentinel event analysis team. Strengthening the integration of performance variability in sentinel event analyses could improve the analyses performed, and lead to more effective improvement measures specifically aimed at optimizing human performance within the healthcare system.

In the Netherlands, approximately 2.300 workers have a serious reportable accident at work every year, of which around 60 are fatal (Inspectie SZW, 2020; Bellamy et al., 2014). Safety practitioners employ many methods to improve occupational safety for workers within their companies. Interventions might, for example, be aimed at improving companies’ overall ‘safety culture’, at the introduction of a safety management system (e.g. Robson et al., 2007), or at improving the compliance of workers to specific safety rules (e.g. Peuscher and Groeneweg 2012; Bryden et al., 2016). However, the effectiveness of many of those interventions remains largely unclear (Dyreborg et al, 2015). The Dutch National Institute for Public Health and the Environment (RIVM) has started a project with the ultimate goal of developing a database filled with effective safety interventions. Developers can submit their interventions using a fixed protocol. To support this project, we developed a survey, which was sent to all members of the Dutch Society for Safety Science (NVVK). In the survey, we used a list of 48 predefined descriptions of common interventions. Respondents could indicate whether they made use of these common interventions and the extent to which they considered these effective. The survey thus provided an extensive overview of the use and perceived effectiveness of 48 specific safety interventions. In the future, these insights can support the development and testing of more effective safety interventions.

Research question What is the influence of general management trends and research into causes of accidents on safety management? Method The literature study is limited to English and Dutch books, documents and articles in the scientific, professional, and technical literature from the period 1988–2010. Results and conclusions Quite some developments occurred in the occupational safety domain. During the period concerned three models are developed, the Dutch Tripod Model, the Swedish Occupational Risk Unit Model (QARU), and the Dutch Occupational Risk Model (QRM), a barrier based model founded on the bowtie metaphor. These models address occupational accidents from different perspectives, and surprisingly similar factors. While terminology differs, these factors are called basic risk factors, situational, or management factors. Self-regulation of companies has been a strong stimulus for research on safety management systems and audits. Traditionally research in management related topics has not been part of safety research, and thus it has to be developed. While the quality of this type of research is rather low, a general structure of safety management systems is related to the Rhineland management concept. Such evidence is found in new management models such as the EFQM/INK and, to a lesser extent, Corporate Social Responsibility (CSR). While organisational learning, its quality and effectiveness on occupational safety is not researched in this period, research interests are focussing on other organisational aspects like safety culture and climate, including a renewed interest in human behaviour.

Objective What is the influence of general management trends and safety research on managing safety? Method A literature study which is limited to original English and Dutch books, documents, and articles in relevant scientific journals, for the period 1988–2010. Results and conclusions Safety science does not yet have a unifying theory, which betrays its young age as a scientific discipline. In the period concerned, well-known theories, models and metaphors are established or re-issued, including the High Reliability Theory, the Man-Made Disasters and the corresponding Disaster Incubation Theory, and the Normal Accident Theory. The Swiss cheese metaphor takes its final form, the bowtie metaphor and the Drift into Danger model are published. All these theories, models and metaphors emphasize organisational aspects of major accidents in high-tech-high-hazard sectors. General management trends highlight the importance of external stakeholders, which are only reflected in the Drift into Danger metaphor. These developments must be considered in the context of a dynamic influence of external factors, like a decrease in government influence coinciding with strong market and technology developments, which can conflict with safety requirements for high-tech-high-hazard companies. Organisational/safety culture and risk/safety management systems take off during this period, both in terms of academic research and consultancy activities for companies. Whether these concepts will have a lasting influence on safety levels in companies is yet to be seen, given the unclear relationship with major accident processes. Research findings show that many companies suffer from sloppy management, having only a limited insight into possible disaster scenarios.

BackgroundThe recurrence of sentinel events (SEs) is a persistent problem worldwide, despite repeated analyses and recommendations formulated to prevent recurrence. Research suggests this is partly attributable to the quality of the recommendations, and determining if a recommendation will be effective is not yet covered by an adequate guideline. Our objectives were to (1) develop and validate criteria for high-quality recommendations, and (2) evaluate recommendations using the criteria developed.Methods(1) Criteria were developed by experts using the bowtie method. Medical doctors then determined if the recommendations of Dutch in-hospital SE analysis reports met the criteria, after which interobserver variability was tested. (2) Researchers determined which recommendations of Dutch perioperative SE analysis reports produced from 2017 to 2018 met the criteria.ResultsThe criteria were: (1) a recommendation needs to be well defined and clear, (2) it needs to specifically describe the intended changes, and (3) it needs to describe how it will reduce the risk or limit the consequences of a similar SE. Validation of criteria showed substantial interobserver agreement. The SE analysis reports (n=115) contained 442 recommendations, of which 64% failed to meet all criteria, and 28% of reports did not contain a single recommendation that met the criteria.ConclusionWe developed and validated criteria for high-quality recommendations. The majority of recommendations did not meet our criteria. It was disconcerting to find that over a quarter of the investigations did not produce a single recommendation that met the criteria, not even in SEs with a fatal outcome. Healthcare providers have an obligation to prevent SEs, and certainly their recurrence. We anticipate that using these criteria to determine the potential of recommendations will aid in this endeavour.

Ever since safety started to be investigated in a consistent manner, around 150 years ago, there has been a tremendous improvement, both in our understanding of accident processes, and in reduction of harm and damage caused by these occupational and major accidents. Major improvements in safety theories, models and metaphors were made after World War II, with the late 1970s till the late 1990s as the ‘golden years’. But still these major accidents occur and they will keep prompting future scientific developments in safety, as they have done in the past. Reducing the frequency of major accidents remains challenging. Improving design and automation, as starting point for safety has its limits due to the complexity of processes and the inability to foresee all safety related conflicts. The modern emphasis to assure the capacity to handle unforeseen events, such as resilience promises to deliver, will become even more important in the future. Inherent safe design on the other hand make a sensible approach when designing production processes for emerging and future technologies, like nano- and biotechnology. Also, it will remain difficult for small and medium sized enterprises to adhere to complicated laws and regulations. In addition, an increased participation of stakeholder groups makes future safety decision-making even more challenging than it already is today. Yet we foresee that there may be grounds for change in which safety rules, laws and regulations are set aside, the bureaucratic approach towards safety is stopped and the focus is on dynamic accident processes detection. Today, methods are developed to automatically assess time-dependant advancement of accident scenarios and barrier degradation. This direction will contribute substantially to a future higher level of safety in different industrial sectors and might alleviate the emphasis on bureaucracy. We end with developments in two countries where safety and safety science is emerging.

BackgroundOrganisations spend a considerable amount of time and effort on diagnosing and analysing risks within their organisation. In the area of occupational and process safety, a myriad of employee survey instruments is available. Many studies show that operational processes play an important role in an organisations overall safety. Yet, so far safety surveys mainly focus on safety measures or operational safety processes. A flexible instrument was developed with which a wide variety of constructs, from different disciplines, can be measured in a consistent and practical way. The resulting survey distinguishes itself from existing safety surveys by extending the scope with the operational processes which are also referred to as the ‘Core Business’.StudyThis study reports on the development of a catalogue of constructs which were derived from scientific literature and practice. Each of these constructs has been developed with a view towards measurability in an employee survey. The reliability and validity for fifteen of these constructs was assessed. Five separate projects have been conducted within a range of organisations operating as high risk industries.ResultsConstruct validity and the dimensional structure of the instrument have been established through exploratory factor analysis and confirmed through confirmatory factor analysis. Diverse aspects derived from motivational and ergonomic approaches to safety proved to be distinguishable in this analysis.ConclusionThe described instrument allows the mapping and quantification of various aspects of the operational process that are, based on existing knowledge, related to the occurrence of incidents.

Last minute risk assessment (LMRA) is a well-known work method to support employees’ risk perception. However, little is known about the effectiveness of LMRA in providing this support. Here, we describe an eye-tracking experiment with which we attempted to gain more insight into the relationship between LMRA and risk perception and to assess the difference between generic and specific supporting questions. Employees from an international energy production and desalination company participated in this experiment by assessing photographs portraying a (staged) work situation and deciding whether it was safe enough to continue activities and which risk factors were present or absent. The results show a consistent interaction effect over several parameters between work experience and the type of supporting questions, indicating that generic and specific supporting questions should be considered complimentary to each other. Furthermore, the results revealed several other challenges concerning real-world application of the LMRA. © 2020 TNO.

The field of safety and incident prevention is becoming more and more data based. Data can help support decision making for a more productive and safer work environment, but only if the data can be, is and should be trusted. Especially with the advance of more data collection of varying quality, checking and judging the data is an increasingly complex task. Within such tasks, cognitive biases are likely to occur, causing analysists to overestimate the quality of the data and safety experts to base their decisions on data of insufficient quality. Cognitive biases describe generic error tendencies of persons, that arise because people tend to automatically rely on their fast information processing and decision making, rather than their slow, more effortful system. This article describes five biases that were identified in the verification of a safety indicator related to train driving. Suggestions are also given on how to formalize the verification process. If decision makers want correct conclusions, safety experts need good quality data. To make sure insufficient quality data is not used for decision making, a solid verification process needs to be put in place that matches the strengths and limits of human cognition. © 2019 by the authors.

The origin of occupational safety, as an area of main interest of the government, the industry, the unions, and scientists starts in the Netherlands at the end of the 19th century. Roughly in the same period occupational medicine becomes a separate domain. Only just after World War II are safety professionals organised in associations. Starting as a ‘Club/werkgroep van veiligheidsinspecteurs’ (Club/Working group of Company Safety Inspectors) in 1947, it changes in 1962 into the ‘Nederlandse Vereniging van Veiligheidstechnici, NVVT’ (Dutch Association of Safety Technicians). In 1978 there is another change into a professional association, and the ‘Nederlandse Vereniging van Veiligheidskundigen, NVVK’ (Dutch Association of Safety Professionals) is formed. In 1986 this association is transformed into a knowledge association, the ‘Nederlandse Vereniging voor Veiligheidskunde, NVVK’ (Dutch Association of Safety Science). Nowadays the NVVK is still a knowledge platform for and by safety experts in the Netherlands. The association is a network of 3000 safety experts in various disciplines and departments, and by far the biggest network of experts on working conditions in the Netherlands. The NVVK is actively involved in changes in legislation and regulations, and also represents the interests of members and safety experts in general. During these 71 years of organised safety professions, major changes in position and content have occurred. © 2019 Elsevier Ltd

Employee behavior plays an important role in the occurrence and prevention of incidents, affecting safety margins. In this study, we examine the potential impact of incidental learning on human behavior in the presence of variation in task design. Incidental learning is the day-to-day on-the-job learning that occurs unintentionally. This learning influences which behavior (schema) is more likely to be activated in the employee&rsquo, s brain. We posit that an incorrect schema can be activated and lead to undesired behavior if the employee is often exposed to (visually) similar tasks that require different behavior. In rail transport, there is a risk of trains passing through red signals. The train driver&rsquo, s behavior plays an important role in preventing these signal passed at danger (SPAD) incidents. In this study we used speed and location data to analyze train driver deceleration behavior during red signal approaches in the Netherlands. The Dutch rail system showed variation in yellow signal aspects and signal distance. An analysis using 19 months of empirical data indicated changes in behavior when the employee had been previously exposed to different behavior requirements in the same location with a similar yellow signal. These results imply that task design can be improved by taking into consideration what an employee is exposed to during other moments of the shift, and not just during the execution of the specific task.

Objective: What influence has research conducted by general management schools and safety research had upon the causes of accidents and disasters in relation to the managing of safety between 1970 and 1979? Method: The study was confined to original articles and documents, written in English or Dutch from the period under consideration. For the Netherlands, the professional journal De Veiligheid (Safety) was consulted. Results and conclusions: Dominant management approaches started with (1) classical management starting from the 19th century incorporating as a main component scientific management from the early 20th century. The interwar period saw the rise of (2) behavioural management which was based on behaviourism, this was followed by (3) quantitative management from the Second World War onwards. After the war it was (4) modern management that became important. A company was seen as an open system, interacting with an external environment with external stakeholders. These management schools of thought were not exclusive, but existed side by side in the period under consideration. Early in the 20th century, it was the U.S. ‘Safety First’ movement that marked the starting point of this knowledge development in the sphere of safety managing, with cost reduction and production efficiency as the key drivers. Psychological models and metaphors were used to explain accidents resulting from ‘unsafe acts’. Safety was managed by training and targeting reckless workers, all in line with scientific management. Supported by behavioural management, this approach remained dominant for many years until long after World War II. Influenced by quantitative management, potential and actual disasters occurring after the war led to two approaches; loss prevention (up-scaling in the process industry) and reliability engineering (inherently dangerous processes in the aerospace and nuclear sectors). The distinction between process safety and occupational safety became clear after the war when the two evolved as relatively independent domains. In occupational safety in the 1970s human error was thought to be symptomatic of mismanagement. The term ‘safety management’ was introduced to scientific safety literature alongside concepts such as loosely and tightly coupled processes, organizational culture, disaster incubation and the notion of mechanisms blinding organizations to portents of disaster scenarios. Loss prevention remained technically oriented. Until 1979 there was no clear link with safety management. Reliability engineering that was based on systems theory did have such a connection with the MORT technique that served as a management audit. The Netherlands mainly followed Anglo-Saxon developments. In the late 1970s, following international safety symposia in The Hague and Delft, independent research finally began in the Netherlands.

Organizational learning is a key success factor for management to improve safety and prevent recurrent incidents. It starts with having insight into the quantity and nature of incidents and deficiencies in general. For employees to report on such occurrences there must be a so-called ‘just culture’ (also considered in terms of its opposite: ‘blame culture’), where issues can be discussed freely and underlying causes investigated and corrected without fear of punitive actions. Although much has been written about just culture in a qualitative manner, there is limited research into the quantification and modeling of its components. Whereas many petrochemical companies have a just culture as a goal on the horizon, many struggle to find the right path to this objective. A literature review of more than 110 scientific papers revealed that just culture is a complex construct with many interrelated components. In this paper, we discuss a survey issued in the Dutch section of a globally operating construction company. The survey contained questionnaires for nine components and the first two steps in the ‘Learning from Incidents’ (LFI) process. The main aim was to model and quantify their relation with just culture and organizational learning capabilities. The questionnaires were checked for construct validity, and correlations with just culture and other components were calculated. The findings can help petrochemical companies find the most effective and efficient route on their journey towards a just culture. The results showed that there is no single ‘silver bullet’ to fix the blame culture in an organization. The long and winding road to just culture involves making changes on a range of organizational characteristics. The most promising aspects are ‘Psychological safety’, ‘Trust’ and ‘Openness’. These three components are the closest related to just culture and have the strongest connections with the other components. They comprise the first two steps in the LFI process. Obviously, by itself the change in culture will not improve safety but a just culture will improve organizational learning capabilities—and that van lead to implementing more effective actions. As such it can provide a sound basis for a further reduction of the number of incidents in the petrochemical industry to the ultimate goal: zero.

Objective Which general management and safety models and theories trends influenced safety management in the period between Three Mile Island in 1979 and Piper Alpha in 1988? In which context did these developments took place and how did this influence Dutch safety domain? Method The literature study was limited to original English and Dutch documents and articles in scientific and professional literature during the period studied. Results and conclusions Models and theories of human errors, explaining occupational accidents were still popular in the professional literature. A system approach was introduced into mainstream safety science, starting in process safety, and subsequently moving into occupational safety. Accidents were thought to be the result of disturbances in a dynamic system, a socio-technical system, rather than just human error. Human errors were also perceived differently: they were no longer faults of people, but consequences of suboptimal interactions during process disturbances. In this period quality of safety research increased substantially, also in the Netherlands. Major disasters in the 1980s generated knowledge on process safety, and soon process safety outplaced developments in occupational safety, which had been leading before. Theories and models in this period had advanced sufficiently to explain disasters, but were still unable to predict probabilities and scenarios of future disasters. In the 1980s ‘latent errors’ appeared in safety literature, and in The Netherlands the concept of ‘impossible accidents' appeared. Safety management was strongly influenced by developments in quality management.

Quantitative Risk Analysis (QRA) is a standard and mandatory tool in some high-risk industries (such as the on-and offshore exploration and production and chemical industry). Presently, the human factor component is often estimated using expert opinions. In practice, experts may use heuristics such as assuming a failure probability of one in ten or one in a hundred. This practice is indicative of a lack of implementation of existing knowledge concerning human error likelihood and human reliability assessment. In this paper, we provide a proof of principle for the quantification of the human factor in QRAs, which we call QRA+. For seamless integration of existing qualitative and quantitative knowledge, we made use of a Bayesian Belief Network. The resulting model provides an integrated and potentially more accurate estimation of the failure probabilities for both technological and human factors and the uncertainty surrounding such probability estimates. Furthermore, it gives insight into the origin of failure probabilities and the interaction of components. This will make it easier for companies to identify which parameters they need to influence to optimise their management of risk. identified which may pose a hazard. Subsequently, hazard analysis makes use of failure data derived from equivalent operation and component failure rates which relate to components of a similar type that have been subjected to a similar environment. In the consequence analysis, a model is created of the system response to a particular fault or hazard. During the risk analysis and summation stage, fault and event trees are combined across all consequence categories and risks are summed. The goal of a QRA is to develop an appropriate model to determine the numerical risk to different exposed groups. See Pasman and Reniers, 2014 for a more elaborate overview of the arrival of the method

We assessed the impact and social rating of an active and a passive music condition implemented with six patients with Alzheimer's disease. In the active condition, the patients used a simple hand response and a microswitch to self-regulate music stimulation inputs. In the passive condition, music stimulation was automatically presented throughout the sessions. Active and passive stimulation sessions were preceded and followed by control (non-stimulation) sessions. The active condition sessions showed an increase in the patients' indices of positive participation (e.g., singing or music-related movements, and smiles) greater than that observed in the passive condition sessions for five of the six patients. Positive intervention effects could also spread to the post-intervention sessions. Social raters (42 care and rehabilitation staff members working with persons with multiple disabilities) favored the active condition on a six-item questionnaire dealing with, among others, conditions' suitability, respect of patients' dignity and independence, and practicality. The implications of the findings as to the plausibility/desirability of an active stimulation condition were discussed.

Risk-taking behavior is an important contributing human factor to incidents and notoriously difficult to influence. A basic premise of approaches to improving safety by putting in extra levels of protection (e.g. the Swiss cheese model) is that providing information on the number of layers in place does not influence the risk-taking behavior of employees. However, anecdotal evidence suggests that people have a "hard-wired" optimal perceived risk level: we compensate for risk-reducing measures by taking greater risks until the desired level of risk is again reached (risk homeostasis). The research presented in this paper shows that communicating the quantity of protection measures in place has a clear and substantial effect on risk-taking behavior and performance. Although the limitations of this study should be recognized, organizations might reconsider conveying detailed information to their employees on the number of safety measures adopted. Preserving ignorance among employees of the enhanced protection in place creates a stronger "safety buffer" as it reduces risk-taking behavior and improves employees’ efforts to make sure that the presumed "last" layer will hold. The practical implications for organizations on how to communicate effectively on safety measures will be discussed.

Public acceptance is a major challenge for the siting of facilities like fracking, carbon capture and storage and wind farms. The offering of compensation to communities potentially helps to create the perception of a fairer distribution of local risks and non- local benefits. This may help to prevent or solve siting controversies. This paper will discuss insights obtained from an extensive empirical research program in The Netherlands on psychological factors that determine the effectiveness of compensation beyond showing that the project is ‘safe’ from a technical perspective. The studies show that when specific non self-evident criteria are met, the offering of host community compensation has the potential to ease the process of siting facilities. The type of compensation offered matters, e.g. contrary to what many local government authorities believe, citizens prefer compensation funds and measures to improve the local economy over monetary compensation. Also, responses to host community compensation are not a simple matter of balancing the cost-benefit aspects of the proposed developments. Social aspects play an important role, e.g. the perceived corporate social responsibility and trustworthiness of the players involved. Consultation of members of an affected community in the process of deciding about compensation is perceived as fair and communicates that the company takes their social responsibility serious. Before this project, there was little empirical research on the effectiveness of host community compensation, and very little was known about psychological factors and how compensation mechanisms work. The knowledge acquired allows project developers and governments to utilize more effective compensation strategies in complex siting projects.

Children with severe or profound intellectual and motor disabilities often present problems of balance and ambulation and spend much of their time sitting or lying, with negative consequences for their development and social status. Recent research has shown the possibility of using a walker (support) device and microswitches with preferred stimuli to promote ambulation with these children. This study served as a replication of the aforementioned research and involved five new children with multiple disabilities. For four children, the study involved an ABAB design. For the fifth child, only an AB sequence was used. All children succeeded in increasing their frequencies of step responses during the B (intervention) phase(s) of the study, although the overall frequencies of those responses varied largely across them. These findings support the positive evidence already available about the effectiveness of this intervention approach in motivating and promoting children's ambulation. Practical implications of the findings are discussed.

Item does not contain fulltext The first of these two studies assessed whether I I participants with multiple disabilities of 5.3-18.2 (M = 10.7) years of age would succeed in combining a microswitch for accessing preferred environmental stimuli and a Voice Output Communication Aid (VOCA) for requesting social contact. The second study conducted a social validation assessment of the aforementioned microswitch-VOCA combination. Data showed that all participants learned to use the microswitch and the VOCA. Moreover, the 10 participants. who received a 1-month post-intervention check, largely maintained their responding. The social validation assessment indicated that the raters (i.e., 110 university psychology students) favored the combination of microswitch and VOCA over the microswitch or the VOCA alone, and hypothetical combinations of microswitches or VOCAs.

A man with multiple disabilities was taught to perform a head-turning response to activate optic sensors embedded in a small spongy structure at his shoulder and produce preferred stimuli. By touching the spongy structure with chin and mouth (i.e., to activate the sensors), the man would clean these areas thus curbing the effects of his drooling. Data showed that the man increased the frequency of his head-turning responses and reduced drooling effects (chin wetness) through the intervention and a 3-month follow-up. Forty university students, who were involved in a social validation assessment, indicated that the intervention was suitable and enjoyable to the man, had a social/educational function, and represented an approach that they supported. Copyright © 2008 John Wiley & Sons, Ltd.

The present study assessed the possibility of assisting four persons with multiple disabilities to move through and perform simple occupational activities arranged within a room with the help of automatic prompting. The study involved two multiple probe designs across participants. The first multiple probe concerned the two participants with blindness or minimal vision and deafness, who received air blowing as a prompt. The second multiple probe concerned the two participants with blindness and typical hearing who received a voice calling as a prompt. Initially, all participants had baseline sessions. Then intervention started with the first participant of each dyad. When their performance was consolidated, new baseline and intervention occurred with the second participant of each dyad. Finally, all four participants were exposed to a second intervention phase, in which the number of activities per session doubled (i.e., from 8 to 16). Data showed that all four participants: (a) learned to move across and perform the activities available with the help of automatic prompting and (b) remained highly successful through the second intervention phase when the sessions were extended. Implications of the findings are discussed.

Enabling persons with intellectual or multiple disabilities to carry out personal care tasks (such as washing and dressing) independent of guidance from parents or staff members and without prolonged interruptions is a relevant educational objective (King-Sears & Carpenter, 2005; Lancioni, O'Reilly, Campodonico, & Mantini, 2001; Sewell, Collins, Hemmeter, & Schuster, 1998). Achieving such an objective is often difficult, particularly with persons whose disabilities also include visual impairments (Lancioni et al., 2006), and staff or parental guidance may continue to be needed (King-Sears & Carpenter, 2005). This guidance can be time consuming for staff members or parents and negative for the social image of individuals because it emphasizes their dependence on others (Lancioni, O'Reilly, & Campodonico, 2002). Attempts were recently made to curb the problem of dependency in personal care tasks with the use of assistive technology, which ensured a combination of verbal prompting and preferred stimuli that were automatically delivered on positive performance (see Lancioni et al., 2002, 2006). Three participants were involved in the intervention programs described in these studies, and they all learned to dress themselves. Although these results are encouraging, two aspects of the technology that was used in the interventions raise some questions. First, prompts were delivered at preset intervals, rather than upon the failure to respond of participants. The latter condition would appear preferable in terms of effectiveness and respect for the dignity of participants (Lancioni, O'Reilly, Seedhouse, Furniss, & Cunha, 2000). Second, the prompts and reinforcing stimuli were all auditory. The possibility of using various types of prompts and reinforcing events would be essential for the generalizability of the approach. The goal of the study presented here was to help three new participants with multiple disabilities acquire independent dressing through an upgraded version of the technology. This technology provided prompts only for the failure to respond and included auditory, visual, and vibratory stimuli as reinforcing events or prompts. METHOD Participants The participants, Sylvie, Floyd, and Alan (all names are pseudonyms), were 37, 27, and 29 years old, respectively. They had encephalopathy with a level of functioning estimated to be in the profound range of intellectual disability. Their age equivalents for their daily living skills were about 3 years or younger on the Vineland Adaptive Behavior Scales-Interview Edition (Sparrow, Balla, & Cicchetti, 1984). Sylvie was deaf and had minimal residual vision that allowed her to enjoy light displays and find fairly large objects within about 1 meter (about 39 inches) in front of her and at the center of her visual field. Floyd was totally blind and had typical hearing. Alan was totally blind and deaf and, contrary to the other participants, nonambulatory. These differences in sensory-motor conditions (representative of common variations among individuals with multiple disabilities) allowed for adaptations and a broader evaluation of the assistive technology used in the intervention presented here. All three participants were considered capable of performing the steps of the dressing task, even though Alan needed some physical support to complete the responses of putting on his underpants and pants because of his physical condition. In spite of their general abilities, the three participants still tended to have breaks in performance that required interventions by staff members. Approval for this research was granted by the Scientific and Ethics Committee of the Lega F. D'Oro, Osimo, Italy. The participants were not capable of signing an informed consent form, so their parents did it for them in accordance with Italian law. Setting, dressing task, recording, and reliability The study was carried out in the participants' bedrooms by research assistants who were familiar with the topic of personal care tasks and the delicate issue of respect for the participants' dignity. …

Education and rehabilitation research with persons with developmental disabilities is often based on single-case designs (with small numbers of ordinal data points collected at irregular intervals) and relies upon graphic display and visual inspection of the data. This paper (a) provides a brief account of some statistical tests, which may serve to supplement the visual inspection process and (b) underlines some of their strengths and limitations to help education and rehabilitation personnel make a reasonable choice among them.

Social validation assessment of microswitch-based programs versus interaction/stimulation conditions for persons with multiple disabilities is a practically relevant research issue that was recently addressed (Lancioni et al., 2002, 2005a). The present study extended such validation assessment by involving a new group of students with multiple disabilities and two new groups of raters: one including teacher trainees and the other parents of children with disabilities. One hundred and forty teacher trainees and eighty-four parents watched videotapes showing the use of microswitch-based versus stimulation programs for seven students. All teacher trainees and parents scored the microswitch and the stimulation conditions on a 7-item questionnaire, the same as that used in previous studies. Data showed that both groups of raters rated the microswitch condition as more positive than the stimulation condition. These results strongly support those of the previous studies. Implications for use of microswitches with persons with profound and multiple disabilities seem unequivocal. Even so, caution needs to be used until additional replications across different cultural environments are carried out.

One major objective of programs for persons with severe or profound intellectual and multiple disabilities is to teach these persons occupational and vocational tasks and to enable them to carry out these tasks independently (Davis, Brady, Williams, & Burta, 1992; Lancioni et al., 1991; Steed & Lutzker, 1997). The performance of such tasks has traditionally been conceived as a form of individual engagement (Siperstein & Leffert, 1997). However, recent research has shown that it is possible to enable persons with multiple disabilities, including visual impairment, to work together with peers and to share familiar tasks (that is, to engage cooperatively in task--hereafter "cooperative task engagement") (Lancioni, O'Reilly, Cognini, & Serenelli, 2001; Lancioni, O'Reilly, & Oliva, 2002).

We assessed the possibility of extending adaptive responding and head control in three children with multiple disabilities through the use of microswitch clusters.The children had previously learned to perform an adaptive hand response and to control head position during that response. They were now taught one or two new adaptive responses (foot lifting, leg touching, or vocalization) and to combine such responses with appropriate head position. Microswitch clusters served to ensure that an adaptive response was followed by positive stimulation only if it was combined with appropriate head position.The results were positive with the children learning the new adaptive responses and combining them with appropriate head position. This performance was maintained during two- or three-month post-intervention checks. During these checks, the children were also successful in using the old adaptive hand response with appropriate head position.The use of microswitch clusters was effective to extend the level of adaptive responding and enhance appropriate head position during this responding. This outcome, which indicates a successful technical replication and procedural extension of previous work in the area, has positive practical implications for educational and occupational programmes for children with multiple disabilities.

This study was a further evaluation of microswitch clusters (combinations of two microswitches) to improve adaptive responding together with correct head position in two persons with multiple disabilities. The two participants were 19.7 and 6.6 yr. old and had profound intellectual disabilities, spastic tetraparesis, and visual impairment. They were initially taught an adaptive hand response that activated a pressure microswitch and produced favorite stimulation. Thereafter, their performance of the hand response produced favorite stimulation only when it was combined with a correct head position (detected through a mercury microswitch). Analysis showed that both participants increased the frequency of the hand response and, subsequently, the percentage of times they emitted this response in combination with correct (upright) head position. In essence, they were able to coordinate constructive occupation with exercise of appropriate posture. Performance was maintained at a 2-mo. postintervention check.

This study evaluated the use of micro-switch clusters to improve response activity and posture with two children with multiple disabilities. The children were first taught a hand response and then required to combine this response with appropriate head position. The micro-switch clusters adopted for this purpose consisted of a pressure or mercury micro-switch for the hand response combined with a mercury micro-switch for the head position. Both children had an increase in the frequency of the hand response and in the percentage of times this occurred in combination with appropriate head position. These changes were maintained at a 2-month post-intervention check.