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Functional communication training (FCT) is an evidence-based intervention that has been widely used and implemented to reduce problem behavior and teach replacement behavior in a variety of settings. Specific procedures have been researched and documented to ensure correct implementation. Functional communication training can be broken into three steps: (a) identifying the function of the problem behavior through a functional behavior assessment (FBA); (b) selecting an appropriate replacement communicative response; and (c) building new skills acquisition through teaching and rehearsal while using reinforcements and extinction.

OBJECTIVE: To determine whether challenging behavior in young children with autism and other developmental disabilities can be treated successfully at lower cost by using telehealth to train parents to implement applied behavior analysis (ABA). METHODS: We compared data on the outcomes and costs for implementing evidence-based ABA procedures to reduce problem behavior by using 3 service delivery models: in-home therapy, clinic-based telehealth, and home-based telehealth. Participants were 107 young children diagnosed with autism or other neurodevelopmental disorders, and data analysis focused on the 94 children who completed treatment. RESULTS: All 3 service delivery models demonstrated successful reduction of problem behavior by training parents to conduct functional analysis and functional communication training. The mean percentage reduction in problem behavior was >90% in all 3 groups after treatment, and treatment acceptability based on parent ratings was high for all groups. Total costs for implementing treatment were lowest for home telehealth, but both telehealth models were significantly less costly than in-home therapy. CONCLUSIONS: This research demonstrated that parents can use ABA procedures to successfully treat behavior problems associated with autism spectrum disorders regardless of whether treatment is directed by behavior consultants in person or via remote video coaching. Because ABA telehealth can achieve similar outcomes at lower cost compared with in-home therapy, geographic barriers to providing access to ABA for treating problem behavior can be minimized. These findings support the potential for using telehealth to provide research-based behavioral treatment to any family that has access to the Internet.

Functional communication training (FCT) is a behavioral treatment that has been shown to reduce problem behavior and increase appropriate communication in young children with autism spectrum disorder (ASD). In this study, we assessed the effects of FCT on targeted and nontargeted problem behaviors outside of the training context, as well as parent stress, for 30 young children with ASD and their parents. Indirect measures of generalization treatment effects were administered prior to and following FCT treatment delivered via telehealth. Children demonstrated significant improvement on both targeted (measured via observation) and nontargeted (measured via checklist) problem behaviors, both within and outside of the training context, and parent stress was significantly reduced following treatment. These results suggest that the impact of FCT may extend beyond the training context for both the children being treated and the parents delivering treatment, even when generalization is not specifically programmed for during treatment.

The use of telehealth technologies to provide clinical services to families of children with autism and other developmental disabilities is a rapidly growing area of research. In particular, remote training of caregivers via video conferencing appears to be a promising approach for disseminating behavior-analytic interventions (Neely et al. in J Dev Phys Disabil 29:849–874, 2017. https://doi.org/10.1007/s10882-017-9550-4; Tomlinson et al. in J Behav Educ 27:172–222, 2018. https://doi.org/10.1007/s10864-018-9292-0). Although remote training offers a number of advantages, it brings a variety of challenges that are unique to this modality. The field would benefit from information on problems that practitioners may encounter when providing these services and how to train caregivers effectively. In this paper, we report on the experiences of 18 practitioners who provided caregiver training via telehealth from four different sites across a 4-year period. We describe a variety of technical and clinical issues that arose during service delivery, suggest strategies for preventing and remediating problems, and include case descriptions and data to illustrate our experiences. This information may help prepare practitioners to deliver telehealth services and guide further research in this area.

BACKGROUND: Many children with autism spectrum disorder (ASD) have problem behaviors that interfere with learning and social interaction. METHODS: This randomized controlled trial compared treatment with functional communication training (FCT) to “treatment as usual” for young children with ASD (n=38, ages 21–84 months). FCT was conducted by parents with training and real-time coaching provided by behavioral consultants using telehealth. RESULTS: FCT treatment via telehealth achieved a mean reduction in problem behavior of 98% compared to limited behavioral improvement in children receiving “treatment as usual” during a 12-week period. Social communication and task completion also improved. CONCLUSIONS: For children with ASD and moderate to severe behavior problems, parent-implemented FCT using telehealth significantly reduced problem behavior while ongoing interventions typically did not.

Functional communication training (FCT) is a widely used and effective function-based treatment for problem behavior. The purpose of this article is to present two cases in which FCT was unsuccessful in reducing the occurrence of problem behavior displayed by two young children with an autism spectrum disorder. Both children received the same functional analysis plus FCT treatment package via telehealth that had proven to be highly successful for the other participants. The FCT package was conducted within tightly controlled single-case designs for each participant, which permitted subsequent analyses to determine why FCT was unsuccessful. These analyses suggested distinct reasons for the treatment failure for each child. Although the negative results of treatment appeared to be similar for both children, the specific reasons for treatment failure were highly individualistic and identifiable via the single-case analyses conducted. We present findings from both our initial and subsequent analyses and discuss the implications.

Importance Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder. Previous surveys have reported a steady increase in ASD prevalence in US children over the past decades. Several behavioral therapies and medications have been developed to treat the symptoms of ASD; however, little is known about the current status of treatment usage for children diagnosed as having ASD. Objective To estimate the prevalence and treatment patterns of ASD among US children using nationally representative data. Design, Setting, and Participants This study used data from the 2016 National Survey of Children’s Health, a nationwide, population-based, cross-sectional survey. We included 43 032 children aged 3 to 17 years. Data were collected through questionnaires completed by a parent or guardian. Data were analyzed from February 2018 to March 2018. Main Outcomes and Measures Outcome variables included ASD diagnosed by a physician or health professional and the use of behavioral treatment or medication treatment among children with ASD. Results Of the 43 032 included participants, 22 072 (51.3%) were male, and the mean (SD) age was 10.7 (4.4) years. The weighted prevalence of ever-diagnosed ASD and current ASD were 2.79% (95% CI, 2.46-3.12) and 2.50% (95% CI, 2.21-2.79), respectively. The state-level prevalence of ever-diagnosed ASD varied from 1.54% (95% CI, 0.60-2.48) in Texas to 4.88% (95% CI, 2.72-7.05) in Florida. Nationally, about 70% of children with current ASD (70.5%; 95% CI, 65.1-75.8) were treated; 43.3% (95% CI, 37.4-49.2) received behavioral treatment only, 6.9% (95% CI, 3.7-10.1) received medication treatment only, and 20.3% (95% CI, 16.5-24.1) received both behavioral and medication treatments. The remaining 29.5% (95% CI, 24.2-34.9) of children with current ASD did not receive either behavioral or medication treatment. Conclusions and Relevance This study showed that the prevalence of ASD in the United States was relatively high, and it varied substantially across US states. Almost 30% of US children with ASD did not receive behavioral or medication treatment, which calls for a critical need to understand and address the barriers for those children to receive appropriate treatments.

We conducted a retrospective analysis of consumption of classes of reinforcement during functional communication training (FCT). The four participants were diagnosed with an autism spectrum disorder and displayed problem behavior maintained by positive (tangibles) and negative (escape from demands) reinforcement via a functional analysis (FA). In Experiment 1 of the current analysis, data were collected on consumption of tangibles, attention, and escape during reinforcement intervals of FCT. As hypothesized, reinforcers shown to maintain problem behavior were often consumed. However, three participants also consumed moderate to high levels of attention, an arbitrary reinforcer not identified by the FA. In Experiment 2, we studied the relationship between quality of attention and consumption of attention. Significant correlations were shown between quality of attention and consumption of attention for three participants. These data showed that while classes of reinforcement identified as maintaining problem behavior are consistently consumed during FCT, arbitrary classes of reinforcement might be important to consider also for treatment.

The researchers in the project used telehealth to conduct functional analyses and functional communication training in homes of children diagnosed with autism who displayed problem behavior. Parents conducted all assessment and treatment procedures within their homes while receiving coaching from applied behavior analysts located approximately 200 miles away from them. In this article, the researchers summarize the technical systems they used to develop a telehealth service and the concerns and problems they have encountered using telehealth and provide some guidelines for how to troubleshoot those problems.

We conducted a retrospective, descriptive evaluation of the fidelity with which parents of three children with autism spectrum disorders conducted functional communication training (FCT) in their homes. All training was provided to the parents via telehealth by a behavior consultant in a tertiary-level hospital setting. FCT trials coached by the behavior consultant were conducted during weekly 1-h visits. Parents made video recordings of treatment trials in which they conducted the procedures independent of coaching. We evaluated the levels of fidelity during coached and independent trials within a multielement design and recorded parents’ omission and commission errors during different components of the treatment over time. The results showed no consistent differentiation between the coached and the independent trials. Some errors (e.g., omission errors associated with reinforcing manding) occurred more frequently overall, but none of the errors appeared to have a strong relationship with treatment outcomes. All children showed substantial reductions in problem behavior during the final treatment trials and especially during the coached trials. These results suggest that behavior analysts can use telehealth to implement FCT with acceptable fidelity and to achieve substantial reductions in children’s problem behavior.

Behavior consultants conducted functional analyses (FAs) via telehealth with 20 young children with autism spectrum disorders between the ages of 29 and 80 months who displayed problem behavior and lived an average of 222 miles from the tertiary hospital that housed the behavior consultants. Participants' parents conducted all procedures during weekly telehealth consultations in regional clinics located an average of 15 miles from the participants' homes. Behavior consultants briefly trained parent assistants to provide on-site support for families during consultations. FAs completed within a multielement design identified environmental variables that maintained problem behavior for 18 of the 20 cases, and interrater agreement averaged over 90%. Results suggested that behavior analysts can conduct FAs effectively and efficiently via telehealth.

Functional communication training (FCT) was conducted by parents of 17 young children with autism spectrum disorders who displayed problem behavior. All procedures were conducted at regional clinics located an average of 15 miles from the families' homes. Parents received coaching via telehealth from behavior consultants who were located an average of 222 miles from the regional clinics. Parents first conducted functional analyses with telehealth consultation (Wacker, Lee, et al., in press) and then conducted FCT that was matched to the identified function of problem behavior. Parent assistants located at the regional clinics received brief training in the procedures and supported the families during the clinic visits. FCT, conducted within a nonconcurrent multiple baseline design, reduced problem behavior by an average of 93.5%. Results suggested that FCT can be conducted by parents via telehealth when experienced applied behavior analysts provide consultation.

Behavior consultants conducted functional analyses (FAs) via telehealth with 20 young children with autism spectrum disorders between the ages of 29 and 80 months who displayed problem behavior and lived an average of 222 miles from the tertiary hospital that housed the behavior consultants. Participants’ parents conducted all procedures during weekly telehealth consultations in regional clinics located an average of 15 miles from the participants’ homes. Behavior consultants briefly trained parent assistants to provide on-site support for families during consultations. FAs completed within a multielement design identified environmental variables that maintained problem behavior for 18 of the 20 cases, and interrater agreement averaged over 90%. Results suggested that behavior analysts can conduct FAs effectively and efficiently via telehealth.

This chapter will be basic foundations. The theory behind operant conditioning will be the first part of the chapter. Next terms and concepts will be reviewed such as reinforcement, shaping, etc. The presentation of these concepts will include applications to autism. The chapter will conclude with current developments in theory (e.g., functional assessment, positive behavioral supports)

The effects of manipulations of task variables on inaccurate responding and disruption were investigated with 3 children who engaged in noncompliance. With 2 children in an outpatient clinic, task directives were first manipulated to identify directives that guided accurate responding; then, additional dimensions of the task were manipulated to evaluate their influence on disruptive behavior. With a 3rd child, similar procedures were employed at school. Results showed one-step directives set the occasion for accurate responding and that other dimensions of the task (e.g., preference) functioned as motivating operations for negative reinforcement.

Although many substance abuse organizations offer case management services, little is known about clients' satisfaction as consumers of case management services. The purpose of this study was to evaluate consumer preferences regarding the delivery of case management services in a rural substance abuse treatment program. For this study, 120 clients (30 in each of four research conditions) were interviewed about their experiences in the Iowa Case Management Project (ICMP), a fieldbased clinical trial evaluating a strengths-based model of case management for rural clients in drug abuse treatment. A mixed-method approach evaluated clients' responses from a semistructured interview. Most clients preferred meeting with their case manager in their own home. Clients also stated that they preferred specific characteristics of case management services- namely, convenience, privacy, comfort, and accessibility. Finally, clients wanted more time with their case managers over time. Although clients in drug treatment are not often considered as consumers, we found that client satisfaction with case management services could be studied and that clients appreciated being asked about their experiences. By targeting perceived and actual barriers to meeting with case managers (e.g., availability of transportation), service utilization by clients may be increased along with overall satisfaction. Keywords: case management; client satisfaction; drug abuse treatment Over the past century, case management has been implemented with increasing numbers of clients for increasing numbers and types of problems. Originating as early as the 1860s in settlement house work with immigrants and the poor (Tahan, 1998; Weil & Karls, 1985), case management has since been applied in the behavioral health fields of mental illness (Curtis, Millman, Struening, & D'Ercole, 1998; Walsh et al., 2001), substance abuse (Heinemann, Corrigan, & Moore, 2004: Siegal et al., 1995), and co-occurring disorders treatment (Drake et al., 1998; Jerrell & Ridgely, 1999). In behavioral health, case management has been tailored for use across a myriad of settings, including rural and urban locales (Clark, Leukefeld, & Godlaski, 1999; D'Ercole, Struening, Curtis, Millman, & Morris, 1997; Hall, Carswell, Walsh, Huber, & Jampoler, 2002), emergency rooms, nursing homes, schools (Tahan, 1999), prisons (Warner & Leukefeld, 2001), community settings (Lehman, Dixon, Kernan, Deforge, & Portrado, 1997; Weisman & Lambarti, 2002), the client's home (Weisman & Lambarti, 2002), and many other locations. The rapid growth of case management has paralleled an increasing interest in strategies for cost reductions in treating addiction and mental illness (Huber, 2002; Jerrell, 1996; McLellan et al., 1999). Outpatient case management has been viewed by the health insurance industry as a cost-effective mechanism for integrating, coordinating, and advocating for individuals and groups requiring extensive health care services (Huber, 2000; Powell, 2000). The push for effective and efficient service delivery has resulted in a demand for demonstrated effectiveness of case management services. However, the case management outcome literature at present has been described as "large, rapidly expanding and full of anecdotal reports and poor quality research studies" (Holloway & Carson, 2001, p. 25). Because case management has expanded so rapidly and widely, no clear consensus has been reached regarding what case management is and what it does (Huber, 2000; Tahan, 1999). Rather, multiple definitions and models of case management are currently in use. However, at least two of these definitions of case management have direct relevance to the field of social work. Case management was defined by the interdisciplinary Case Management Society of America (CMSA) as "a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's health needs through communication and available resources to promote quality cost-effective outcomes" (CMSA, 2002, p. …