Journal homepage: wivw.elsevier.comilocstelicbs Content lists available at ScienceDirect, Journal of Contextual Behavioral Science Using acceptance and commitment training to enhance the effectiveness of behavioral skills training Alexandra Little’, Jonathan Tarbox", Khaled Alzaabi* vey of Souter Califor nd Learn and Bb! Cnr, Unite Ses ° Ueno Saher Calf nd ose fr Kid Une Ste ® “Tae purpoe of hs study iso lnveigte dhe se of cretance and coramltment traning (ACT vo enhance the eectvence of bbavior slewing GST) wed within a fmthe‘alner model in the context ofan dum cine. The study wlllaed an ABC design embedded witha a mutple buseline across staf tainer areipasts, who were working in applied debater analysis tl ane os. Each parUlpat received alla BST wainng on hoo Use BST to Wa jul evel Sal for how they were cespansbl for alain. ACT ainig was then aed inorder to evaluate wher would enbunce the eeeveness of BST. The dation of ACT wat founé to be effec in eabancng the performance ofall tuners, the reultsgeneraliedacroe raf and cents who were nok pesent ding ACT telnng, and maintained after ACT tralng was temnated A substantial amount of research has established the effectiveness of applied behavior analytic (ABA) interventions for individuals with sutism (Virsés-Ortegs, 2020), This research has led to laws requiring insurance companies to fund ABA treatment, resulting in large and "rapid expansion in the demand for ABA services (Glass, 2015). As the field grows, 0 does the need for quality therapists and the training of ‘behavioral therapist i therefore more important today then pechepe ever before, While substantial research hae shown whieh training pro- cedures ate effective, many ABA clinics é0 not implement empirically validated models consistently Behavior skils taining (BST) is among the most seientiiealy sup ported procedures fr taining staff (Parsons, Roly son, & Reid, 2012) Behavior sil training (BST) involves a three-step model (Nigto Bra & Sturmey, 2010). The fist step is verbal instruction in which the leainer provides a description ofa ski, diseases the importance or rationale, and when to and not to use it The second step consists ofthe trainer modeling how to perform the ski, The thied sep consists of roleplay rehearsal with feedback, which allows the individual to practice the skills and receive immediate feedback from the trainer. During this step, the trainer provides praise for correct responses and corrective feedback for incorrect responses. Role-play with feedback is renerally continued until the trainee demonstrates accurate perfor- mance according to a predetermined criterion, for example, at least 90% correct implementation. ‘Asubrtantial amount of research shows the effectiveness of BST in training a variety of ABA sills. Ssrokoff and Sturmey (2004) evaluated the use of BST to vain three special education teachers working with Grrerponding suet. ‘Ema drs jarbox@uscedu (J. Tarbo eps. org/10.1016/ jb. 2020.02.0 chil with ASD to implement discrete trial training (DTT). The results Show that BST produced rapid improvements in the teacher’ im plementation of DIT (Sarokotf & sturmey, 2004). Adkltionally, pre ious research used BST to teach staff to implement mostto-least ‘prompting, a well as how to use manual signs for communication with liens (Parsons etal, 2012). In this study, the researchers provided a ‘writen description of the target skill during the verbal explanation phase, asi often done in BST. Following the intervention all partic Pants showed an increase in proficient use of most-to-least prompting as ‘well as signing sil ‘Substantial research such as that deseribed above provides evidence for the effesivenes of BST, but it may be dificult to use a standard BST model to trai sufficient numberof staff in a raplé enough manner to meet the demand. An alternative to having one expert trainer se BST to directly train all staf in an organization, isto we a train-the-trainer ‘model, The train-the trainer model involves taining mid-level staff to |e BST to train lower-level employees, thus expanding the efficiency of teaining in the organization, Train-thesrainer programs are wsed in multiple fields such ae public health safety, education, and health care (farber etal, 2015). There are multiple advantages to the trainthe trainer programs, however the largest and most epplicable tothe fed of ABA isthe ability to train a larger numberof people per unit of time (Warber etal, 2015). BST has heen wsed with senior staff to teach them ‘how to implement BST when taining new staff within the work setting (@arsons,Rollyson, & Reid, 2013). However, previous research has fo cused on eraning senor staff members to train another staf member in f small nomber of work-related skills, In many ABA clinic, i is ‘Received 21 October 20:5 Received a evite frm 7 Janvary 2020; cepted 19 February 2020 2212-1447/ 6 2020 Association for Contexts Behavioral Science Published by Elever Ie. AI right reservednecessary for new incoming staff co be trained in a variety of work: related shils. This task however can be daunting to senior staff pre- paring to train as they are expected to not only provide effective therapy, but to also provide effective training, Additional research may therefore be needed on ways to enhance the effectiveness ofa BST train thesrainer model, when this model alone does not produce suicient behavior change. Implementing BST inside of tain-the-trainer model can be difi- cult for staff. The job of ABA therapists and trainers working with fa miles with autism is inherently stressful and research suggests Burnout can be a significant problem in this discipline (art, Grist, Mlesky, & MeCoré, 2013). I snot common for ABA training approaches to ad- ares private events, but staff often report that private events play a role in the difficulty of implementing effective staff training. For example, twainers may report that they experience private events such as stress, feelings of fatigue or frustration, and thoughts that they ae unprepared for inadequate tothe tisk of training. If treated ax hypothetical internal causes of behavior, these covert variables are of ite us in a science of Dehavior. However, when teated as private environmental events, for example as aversive stimuli and maladaptive rules or discriminative stil, should be possible to adress them ina behavioral approach to staf traning and performance, I private events are simply behavior and/or environment, then they should be amenable to analysis and intervention according to the same behavior analytic principles that govern everything else we do in behavior analysis, in adéressing {functional relations between overt behavior and environment (Skinar, 1974), 1. Behavior analytic perspective on acceptance and commitment training ‘Acceptance and commitment training (ACT) Is a contemporary be- havior analytic approach to addressing the unhelpful role that private events sometimes have in influencing socially meaningful overt beha- ior. ACT was originally developed as a behavior analyte approach to psychotherapy and is stil called acceptance and commitment therapy when implemented in that seting. More recently the term acceptance and commitment vaining has been used to refer fo ACT when iti ap- plied in noa-peychotherapeutic settings. ACT is a mindfulnessbased approach to behavior change that focuses on increasing behavioral Aexibiliy. A foundational conceptual functional analysis atthe foun- dation of ACT is that sub-optimal performance often involves behavior that is maintained by escape from or avoidance of aversive private events, referred to “experiential avoidance” in the ACT literature (ayes, 2004). Asan alternative to escape-maintained behavior, ACT sims to train individuals to function effectively in the presence of thallenging private evens by behaving more flexibly and toward overt, larger and long-delayed postive reinforces, referred to as “values” in the ACT literature Interventions informed by ACT target six component repertoites of Dehavior (referred to as “processes” in the ACT bterature), all of which, interact with one another, o achieve socially meaningful overt beha- vior change (Hayes, Pistorllo, & Levin, 2012). The terms comprising the hexaflex are not technical terms in behavior analysis, bu all are intended to be understood functionally. Hach refers to both: 1) a sil "repertoire consisting of complex funcional relations between behaviors and environmental events, and 2) procedures used to strengthen these ‘behavioral repertoires (much in the same way asthe term “reinforce- ment” refers both toa relation between behavior and consequences that strengthen it, as well as to procedures wsed to reinforce behavior in practice). ‘Values. From a functional analytic standpoin, the term values refer to large classes of verally constructed, highly potent, long-term pos Live reinforcers. For example, seing a child sueceed in school, hearing parent tell you that they are able to take ther child out to eat at a restaurant forthe first time, and seeing that child make friends andl succeed socially, may be in hierarchical relational class with values statements such as “making a diference as & behavior analyst.” As procedures, values based interventions involve statements or rules that funetion as verbal motivating operations (e., avgmentals), that in crease or decrease the elfectiveness of stim at reinforcers oF pun ishers, in turn supporting committed action in the form of overt bea ior. For example, within a staff training model, the clinial director may ask the staff wainer “What drives you to come into work each day?" The staff trainer may say something along the lines of "T care about helping kids with autism be able to be more independent and reach their fullest potential." The clinical director coulé then link the imporcance of providing quality training to new staff with that trainers value of helping children. For example, “Tean éraw a dizeet line be- toveen each hour that I put into taining saff and the outcomes their liens are going to have inthe future If do a grest jb attaining, ‘ould Iteraly make the difference for a kid being able to learn the ‘words to say,‘ love you’ to his mom for the fis time." Contacting values” verbal stimull such as these may work by making training, Itself, less aversive or more positively reinforcing, theough transfor mation of stimu finetions, in accordance with the verbal network involved in the previously contacted augmental Present moment attention. Present moment attention as a beha- ioral repertoire can be described as an ingividval’ behavior of at tending t stimu in the present moment more and attending to one's wa verbal behavior surrounding the past. fture, oF imagined events les. For example, in the context of providing staff training, a strong repertoire of present moment attention forthe trainer would consist of most of her attending behavior being oriented to the trainee, the client, and other relevant variables of the training situation, A relatively ‘weaker present momeat repertoire forthe trainer could involve more of her attending behavior being directed to private stimuli, such as the ‘hought If el this person they arent doing good job, they might nat like me, o they might qui In addition to paying attention to the present moment, present rmomentatention behavior involves learning to attend fo one's ovn attending behavior, which becomes, itself, part of the array of presen ‘moment stimuli o which one attends, Tis ean involve noting and tacting one's own attending behavior, including when itis inthe pre sent, veravs when it wanders, which con then serve asa discriminative stimulus for redirecting one's attention back tothe present moment. Put differently, present moment attention involves building the repertoire of selirmanaging ones own attending behavior. For staff ainers, a strong present moment repertoire could involve noticing when they are sctually paying attention tothe staf member they are training, versus when they are attending to their own problematic private events (eg. "Am I good enough at ABA co be teaching iO"). The behavior of tacting lone’ attention to one's own private events may then serve as a dis triminative stimulus for the staff trainer t retura to the present mo- ment, much like the behavior of noticing oneself not paying attention hile diving may help one orient one attention back to driving, When fone is more engaged in atending to one's own dificult private events {his may encourage behaviors that avoid situations that evoke those private events, for example, avoid giving a new staff member mean ingfal feedback. Put another way, it seems plausible that practicing present moment attention strengthens present moment attention re Pertoires of behavior, resulting in a person engaging in that repertoire ‘olatively more frequently, therefore leaving relatively less time to engage in attending to evaluative verbal private events ‘Acceptance. As a behavioral repertoire, acceptance can be con ceptualized asthe behavior of saying present (as opposed to avoiding fr escaping) when presented with aversive stimulation and perhaps even actively moving toward the aversive stimulus. For example, if a teainer experienced the aversive thought (private verbal behavior that produces private verbal stimulation) “The trainee doesnt think I am ‘qualified to tran her,” rather than engaging in avoidance behavior, er such as canceling thei raining session, an acceptance repertoire couldinclude purposefully observing the thought and then showing up fo the training session, Acceptance training often Involves practicing obeer- ving, noticing, and “making room for" aversve private events Acceptance a8 @ behavioral repertoire, then, involves contacting aver= [As a procedure, acceptance training involves prompting and re- inforcing mltiple exemplars of exposure to aversive stimuli without engaging in escape behaviors. For example, if a staff trainer has the ‘thought "She's going to freak ovt if [give her corrective feedback, rather than avoiding giving feedback, the crainer might write the thought on a piece of paper and hold it in her hands. Or when checking her email, instead of avoiding reading a message from an angry staff member, the trainer might read the message and notice how her heart rate elevates, skin fesle warm, of how she feels angry or annoyed, The rationale for acceptance is chat, f one's repertoire of escaping aversives is weakened, it can provide more opportunity to engage in a varity of other behaviors that could lead to positive reinforcement (, having meaningful, constuetive taining Session witha teanee). In this way, a previously aversive private event that may Tea to avoigance or escape Dehavior may now be an accasion to access positive reinforcement by engaging in a values-irected behavior Defusion. Asa behavioral repertoire defusion can be described asa ‘weakening of rigid rule control over behavior, Behavioral repertoires labeled as “defused” consist of broader, more flexible respanding to aversive private events, particularly those involving unhelpful rules describing avoidance behavior Its often useful to contrast defusion (an adaptive repertoire of behavior) with fusion,” a maladaptive repertoire of behavior that defusion is meant to weaken. Behavior that i labeled a5 “used” involves responding rigidly and in an overly “compliant” ‘way with ones own unhelpful rules regarding aversive stimuli. For example, overly rigid responding to the thought “I am an introvert” ‘when providing staff training might encourage the trainer to avoid tiving feedback. A more defused repertoire might involve noticing the thought “Lam an introvert” and then tying a few different ways to respond to that thought in the context of training (e.g. sometimes staying silent, sometimes giving feedback, sometimes asking the trainee a question) To strengthen thes flexible defusion repertoires of behavior, defu- sion procedures teach a trainee a variety of flexible ways of responding to their own private events. For example, if a staff trainer has the ‘thought, “Why did I get promoted? People are going to find out that Tm. ot realy ready for this job,” the trainer may engage in technique that disropts the inflexible private even that may lead to excape-maintained ‘behavior. For example, she might pause for a moment and imagine that ‘those words are written on leaves Rating down a stream. Or she might repeat the same words back in the voice of « radio announce, in super slow motion, or ina chipmunk voice, ete The goal ifr the staff talner to interrupt their awn avoidance behavior inorder to engage in exible alternative behaviors, to ereate room to potentially engage in more valuesircted behavior Selfas-context. A selfas-context repertoire of behavior invelves variable an flexible perspective taking behavior with respect to oneself and one’s relation to others. For example, a staff trainer who labels themselves as “too shy ofa person,” may “believe” this rule by rigidly following t and avoiding assertive training interactions with staff. This pattern of avoidance behavior could prevent that individual from Contacting their long-term positive reinforcers (eg. becoming experi enced in staff raining). A more flexible prspective-taking repertoire ‘would involve noticing selfjudgments about shyness as one of many differen: labels one could place on oneself and even noticing the act of placing labels as just one of many different behaviors one ean engage in toward oneself ‘AF procedures, selfascontent exercises prompt and give the in dividual reinforeement for practicing looking beyond parteular sel Iabels or judgments and identify multiple possible labels and descrip ‘ons of themielves,SelEas-concext exercises often involve metaphors for looking at oneself asa context or place, rather than thing. For teample, “Life sometimes feels lke a game of chess. But what If you werent one ofthe pieces. What if, no matter how good or bad of & day You were having, you weren' the queen or the pawn, What if you were he board?” Selfas-context exercises also involve prompting people to look fom ather perspectives, sich at “What ifyou were froma diffrent culture, would you be considered shy?” of "How do you think your grandmother sees you?” or “What if you were me, would you think you were shy?” Overall, slf-as-context procedures introduce variability and ‘exibilty around how people see themselves, and strengthen more Aexible verbal behavior oriented toward oneself, suchas "I may be shy but Im going to use BST ané train this person because of my value of making 2 difference ‘Committed action. Helping to support committed action ie the purpose ofthe other five components of the ACT model. As repertoire ff behavior, committed aeton consists of stating which behaviors one is going to engage in, which long-term positive reinforeers (ie, values) these behaviors help bring about, and then actully engaging. in the covert behaviors, For example, a staff member might tate othe director ofthe clini, “Teate about making a difference for families of cildeen with autism, s0 tm going to apply forthe staff trainer postion” and {hen actually submit their application. This repertoire of behavior likly often involves the relational responding that functionally defines rule governed behavior, including tracking and augmenting and is relevant tw the general behavioral literature on goal-setting, outside of ACT. specifi contents (Ohors & Msgliest, 2008), ‘As a procedure, committed action interventions involve the ACT teainer or therapist helping the individual to make goals for specific avert behaviors they ean engage in and how those behaviors connect ‘them to their values. For example, with a director providing ACT. training to a sa trainer, the ditector might give the trainer a work sheet that prompts them fo write down specific vert behavioral goals that move them toward their stated values. The staff trainer may then rite something such ast want ro provide quliy ating in ABA so that my clients can Benefit and lve @ better life. In order to prove quality taining, Ihave to give constructive feedback. Lastly the staff trainer might set realistic goals for herself to target in future situations, such as writing, Iwill provide immediate constructive feedback aftr teaching anew il atleast five times per tession that [observe a new ABA therapist and then commit to that goal with someone else (e.g. tll their director or another trainer) ‘The six component behavioral repertoires described above can be analyzed and addressed separately, as was dane above, but the purpose of al of them isto support commited values-drected action. For ex ample, if one is willing o experience difficulty (acceptance), then one an have the opportunity co do hard thing that they eare about. Ione contacts thelr values directly in the moment (eg, “I eate more about helping kids with disabilities than I do about feling comfortable”), then doing the hard work that committed action involves ean actually be less aversive. Ifone takes their own negative seléthoughts less ser- ously (fusion), then one is less likely o rigidly follow them as rules and therefore one has more opportunity to engage in overt commited action, In shor, strengthening all ofthe sx epertires involved in ACT can come together to help individuals gain mare adaptive ways of r= sponding to their own aversive private events, in turn changing overt behavior and providing an individual with more access to the postive reinforcement that valuee-directed action can bring about 2. ACT for training therapists A variety of research and books have investigated the effets of ACT training on tres and therapist skills in varios clinial environments Gond, Lloyd, lawman, & Aeeher, 2016). A recent study evaluaced the effects of verbal and written performance feedback Intervention in addition to ACT, which demonstrated an inerease in active teatment and technical performance following the intervention (Pingo, Dixon, &Palilunas, 2018). Given that ABA practitioners are under significant levels of tress in their day-to-day interactions with clients the addition of having to tain a new employee could add to those stress Ievels, decreasing their effectiveness in taining Research hat investigated the effect of ACT training on stress and therapist skills ina clinical psychology setting (Pakenham, 2015), Pax kenham investigated how ACT training effects stress levels, as well as therapist skills and attributes, Results shoved that ACT training had benefits for both skill development, as well as personal benefits fr the linical therapists, overall providing a strong connection between ACT processes and the clinical traine's professional and personal outcomes. Areceat study by Chancey etal (2018), used a series of workshops ‘twhave direc caregivers engage in minefulness techniques, s well sto educate the participants on the definition and purpose of mindfulnese. The results showed that mindfulness techniques are effetive at im- proving caregiver interactions towards clients. In addition, the use of Committed action techniques has been shown to increase instances of engagement with adult clients in a day treatment program (Castro, Rehfldt, & Root, 2016). The experimenters conducted a series of ACT lesining workshops with direct sevice professionals, engaging in eX excises that focused on work centered values, Rests showed that in teractions with their clients increased ffom an. average of 11 interne- Lone per session at baseline to 16 interactions per session following Previous esearch has shown the effectiveness of the tainthe- trainer approach, as well as the integration of a train-the-rainer ap- proach to teaching staff to conduct behavioral sls training. However, little or no previous research has evalueted the possibility that adding [ACT could enhance the effectiveness of train-the-trainer mode of BT. ‘As such, she purpose of this study was to apply ACT to a tain-the ‘wainer model to enhanee of BST use by sta wainers when training new staf in the context of an ABA cline fr cildfen with autism, 3. Method 3.1. Paricipants and seting ‘Three staf trainers who worked with children with autism at an [ABA clinic participated in this study, Trainer 1 was a 50-year-old female ‘who ha¢ worked in the field of ABA for 13 months, wainer 2 was a 36- year-old female who had been working inthe feld of ABA for more ‘than ten years, and trainer 3 as a 24-year-old female who had heen. ‘working in the field of ABA for 6 years. All the participants were pro- moted to staf trainer positions around 2 weeks prior to the start ofthis study. The participants had not received training in how to tain new staff members prior to this study. Asis common within the organization site, the staff members were not instructed in how to tain new em Ployees until they were promoted to trsining postions. The three par- Uelpants were chosen for this experiment based on thelr high level of performance in executing applied behavior analytic interventions di rectly with clients A participants gave informed consent to be a part ofthis sty All sessions took place in a center-based ABA clinic that provided intensive ABA treatment services to children with autism, Observations of staf trainer participants were conducted while they conducted their ‘normal daily job, training junior-level staff i the center while those juniorlevel staff worked with children with autiom, Experimenter-i plemented BST and ACT training sessions were conducted one-on-one ina designated training office. All BST and ACT training sessions were conducted by the same experimenter (first author) and took place outside ofthe staff trainer participant's regular work hours 3.2. Response measurement Primary dependent variable. The dependent variable wat the eof opportunities in which staf trainer participants Implemented BST while working with Junior level staf. The definition of BST implementation included: 1) the Wainer parteipant verbally describing the sil to the junior level staf, 2) the trainer parteipant demonstrating how to implement the sill with the client, 3) having the junior level therapist implement the skill with the eliet, and 4) the inet participant giving feedback oa the junior level staffs im: plementation of the skill withthe client. An opporcunty was defined as an instance when the senior staff member began verbally describing a Skil, technique, or intervention toa trainee. For instance, ifthe senior staff member began to verbally describe mand training to anew trainee, this would then be considered an opportunity and data would begin to be collected Psychological flexibility. staff trainer participants were asked to complete the Acceptance and Action Questionnaire (AAQ; Hayes tal 2004) before and after ACT taining Social Validity Measure. A socal validity measure was used inthis experiment in which the senior staff members were asked f0 rate var- lous questions on a eale of 1-5, 1 being strongly disagree and 5 being strongly agree. Some questions included were, “I believe that this study has improved my’ ability to train staff members,” “I approve of the acceptance and commitment taining exercises," and “I care about be- coming more effective at waining using behavior skis taining, Interobserver agreement. [0A data veere collected on 35% of sessions for trainer I, 33% of sessions for trainer 2, and 32% of the sessions for Wainer 3. Measures of agreement were calculated by di- viding the total number of opportunities in which both observers scored, cexaclly the same data by the total number of opportunities and mult plied by 100. The overall inter-obeerver agreement averaged 87% for data colleted with trainer 1, 94% for data eolected with trainer 2, and 90% for date collected with trainer 3 3.3. Procedures wseline. During the bassline condltion, all staff trainer parte: pants were assigned a new staff member to train during regulary Schedule sessions with clients who were children with autism, Each baseline session was 20 min in duration. The staff trainer participants were to to conduct their work normally and to provide training tothe junior level staff member. None ofthe participants had received BST on. ‘how to implement BST or any kind of ACT training before this condi tion. No feedback was delivered by the experimenter during this con dition. The experimenter positioned herself in-view but unobtrusive. Observing staff performance during regular ABA sessions in the clinic ‘was anormal daily pat of the experimenters job, so observation fo the purpose ofthis study did not differ substantially from what the staf Fegularly observed her doing on a daily basis. ‘Behavioral Skille Training. At the beginning of this phase, each staff trainer participant received behavioral shils training with the experimenter In @ 1:1 setting in which they were tained to use BST with new safl. The experimenter utilized BST to teach the staff teainer partiipant how fo use BST to train junior-level staf, Lach participant was given a behavioral skills raining worksheet. The worksheet con tained an area for the participants to write down the definitions ofeach aspect of behavioral sills training as it was being verbally desribed to them. The experimenter then modeled to the participant how to use BST to teach a skill toa new staff member, In order to achieve thi the experimenter acted asthe staff rainer participant while the staff trainer participant acte asthe junio-level staff. Then the two switched roles and the experimenter acted as a junior level staff and the trainer par Uicpant acted as themselves. During roleplay the participant was prompted to engage with their worksheet which included an area for them to self-identity when they were corzectly implementing each step of BST. Feedback was provided, consisting of praise for correctly in plemented training techniques and constructive feedback for i correctly implemented techniques, This training continued until the ppartieipant demonstrated a lesst 90% correc implementation of BST inrole-play with the experimenter, resulting in approximately 1h for each partelpant, ‘After the training, and on the same day as the training, the ex perimenter observed the participant doing thei regularly schedule job of observing and training junior level staff a in baseline, AS in base line, the experimenter simply observed the participant unobtrusively and éid not provide feedback ‘Acceptance and Commitment Training, The experimenter con ected a T-h one-on-one ACT training with each participant. Before beginning this taining, cach participant was tolé thatthe purpose of this taining was to help them to become an even stronger trainer (the experimenter didnot sy thatthe purpose of training ws to increase BST tue). The training inchuded exercises commonly reported in the ACT literature, as briefly described below. Present moment attention. Participants were led through the Notice Pive Things and Drop the Anchor exercises, as described in Haris (2007) These exercises were wed to train individuals to pay attention to thelr sensory experience in the present moment. The participants were en- couraged to practice these exercises before thet taining sessions, as wel a any time they experienced dificult private events, Values identification. Participants were then led through the Quick Look at Your Values exercise as deseribed in Hacts (2008). Within this exercise participants were given alist of 60 common value, asked to take notes on their relative importance, and lastly, to write doven the six values that were most important to them in their job a a staff trainer. (Committed action. Finally, the experimenter led the participant ‘through completing the Wilingness and Action Plan as it relates to thelr Job asa trainer (Haris, 2007). This worksheet involved the participant ‘writing down their most important work value, a goal they would like to achieve in moving toward that value, private events that they were “willing to make room for” that may occur in the proces of attempting to achieve tis goal, and finaly, the time, day, an date that they will take the fist small step toward that goal. ll participant identified Using BST mote consistently in thelr jobs as their committed action, although the experimenter never suggested this ‘Approximately 24h alter the ACT aining, participants were again observed during sessions in which they were responsible for taining Juniorlevel therapists sin the Baseline ané Behavioral Skills Training ‘phases. Immediately before the frst two sessions, the participants were prompted via text message to read over their committed action pan. No ‘more prompts were given after the second session in the ACT phase. Similar to the BST condition, the experimenter pestioned herself un- btrusvely and did not provide feedback In der to atsese generalization, the staff trainer participants were observed taining juniorleve therapists with new clients who had not ‘been present previously in the study or during sessions in which they ‘were tasked with training new juniorlevel staf that they had not previously trained, Trainer 1 was observed with two different junior level staff members and a new client during generalization probes. Trainer 2 was observed with two different clients, a well as one new Juniorevel therapist, and tcainer 3 was observed with two different junior level staff members, 4, Results ‘The resulting numberof staff who received raining at each level are depicted in Fig. 1. The experimenter used both BST and ACT to train the three partcipanc trainers. Participant Trainers 1, 2, and 3, then trained six junior-level staff. Not depicted in the flowchart isthe fact that those junior level staf worked with 11 total ehldren with autism. Therefore, ‘ate cost of approximately 6 h of total experimenter training time, 20 Steff and client were affected by the taining. The effets on the primary dependent variable forall participants ace displayed in Fig. 2. During baseline, Trainer 1 engaged in behavior Skis training in 9-14% of opportunities. The behavioral skills taining condition produced an immediate increase, followed by a decrease and Therapist 1 Trainer 1 Therapist2 Therapists Fig. 1. Hlowchart sowing dhe sequence of ualalng and the sumber of stall involved in the study Therapist6 ST use stabilized at 45-50% from sessions 10-13, Following session ‘thirteen, the ACT condition was introduced. No immediate effect wae observed, however inthe second session of the ACT condition, session fiteen, behavior skills taining use increased to 100% of opportunities and remained stable for the remainder ofthe sty, including daring all generalization probes. Trainer 2 engaged in behavioral skills training in 086 of oppor nities during baseline. During the behavioral skills taining. phase, ‘Trainer 2 engaged in behavioral skills talning during 50-55% of op portunities. Following the ninth session, the ACT condbtion was in troduced, There was an immediate effect observed during the ACT condition and the dependent variable remained at 100% forthe re- ‘mainder of the study, aside from session 13. ‘Trainer 2 engaged in behavioral sis training in between 0 and 1396 of opportunities in the baseline phase. An immediate increase was seen during the behavioral skis training phase, eventually stabilizing round §0-66% of opportunities, During the ACT phase, the ependent ‘variable immediately increased to 100% of opportunites and remained stable through the end of the study. Results forthe social validity measures are dispyed in Table 1 Coverall, the results of the social validity messure suggest that the partelpants approved of the goals, procedures, and outcomes of the sud. The lowest score, a score of 3 ("Neither agree nor disagree"), was obtained for Trainer 3 in response (o the question about whether they felt more relaxed after the ACT taining [No systematic changes were abserved on the AAQ. Trainer I's AAQ score change {rom 39 in baseline to 37 atthe end of the study. Trainer 2 scores changed fom 36 in baseline o 42 at the end ofthe stay. ‘Trainer 3's scores changed from 43 in baseline to 34 atthe conclusion of the study, 5. Discussion The purpose of this study was to investigate whether the addition of [AGT to previously researched BST procedures results in increased per formance, in this ease BST use itself, by staff trainers responsible for training new staff in an ABA clinic, Using BST alone to tain tsiners resulked in the trainers using BST to train junior-level staff in ap proximately 50-60% of opportunities, which was a substantial inrease from baseline, These results support the conclusions of previous re- search on BST and show that BST alone is effective. However, when &aseline Behavioral skills Training Percentage of Opportunities Me Soa of ote Beara Sec 16202) 916 act Sessions Fig. 2, Percentage of opportunis trainer partpants lnpemented behav single hur of ACT training for trainers was implemented, it resulted in f substantial increase in BST use across all trainers and the reslts generalized across juniorlevel staff and liens. Overall, the results ‘support previous esearch showing that BST i effective and add to the Iiteratuce by suggesting that the addition of AGT may substantaly in trea the effectiveness of BST when training tants ‘No systematic changes were observed on the AAQ measure of psy chological flexibility. However, since the measure was implemented ‘only onetime during baseline ai one time atthe end ofthe study, tis ‘not possible to evalvate any changes inthe context ofan experimental design and a sample of only three participants precludes any statistical analysis ofthe data. I is interesting to note, bowever, that Participant 1's scores did not change, Participant 2's scores worsened somewhat, and Participant 35 scores improved, despite the faet thatthe cffect of oc sllsalaig with unior-eve taf eos all phases of the study the ACT intervention was similar acrot all ehee, Although the sample size is fer to small to draw any firm conclusion, it appears as though, the AQ change seores in this study were not meaningfully related to response-to-teatment orto performance at the end of the sudy. ‘As the field of applied behavior analysis continues to grow, s0 does the need for quality taining within ABA agencies. Previous research nas supported the effectiveness of train-the-eainer models as well as ‘behavioral sil training, Pechaps the most encouraging implication of the current study is that ACT may contribute to making rapid training and dissemination procedures more effective. I€ also seems plausible that these implications have relevance outside the practice of ABA. ‘Many other helping professions suffer from a lack of dissemination of ‘evidence-based practices and i is possible that the I h ACT training for teainers evaluated in this study could be tested for training trainers in Tablet Socal Vay Ress. Questions were rated from I = Strongly Disagree, to 5 = Strongly Agree. ee Taine Trane 2 Tralee 3 ese eee hat sy bar nprved my ably oe ah 5 5 + a "ee an lng sal ees re ely ‘ 3 4 a {eae about beconing mere ctv at ciig tng bball sng 5 5 5 5 Aer be ACT ning eel a mug tam mate ele ing yang Son ‘ : 3 :other elds, such as psychotherapy, qursng, soci work, and other professions that require trainers to perform In the context of ses, sl doubt, and other challenging private events Some aneedotal observations ate worth mentioning. Partiipants reported atthe end of the study that they felt calmer during training sessions. Changing private events, such as anxiety, is not the goal of ‘ACT generally, nor was it the target of the current ACT training for trainers. Nevertheless, it may be a desirable side-effect that could en- hance the social valiity of ACT for those who receive te training, Ie is also worts noting however, that feeling more calm was te question on the socal validity questionnaire that received the lowest rating, rating of 3 from one participant. In addition, the experimenter anecdotally observed that the trainer and trainee appeared less stressed, more re- laxed, and the session “flowed better” towards the end of the study. From a functional stanépoin, if trainer was attending more to the session and less to her own aversive private events as a result of present moment training, it seems plausible that she would be better able to respond rapidly and with greater nuance to subtle cues provided by the therapist and clients Behavior. In other words, if the trainer i Tess Aistraced by erelevant stimuli follows that she could perform more Auently as a trainer. No data vere collected on this potentially im- portant qualitative aspect of the trainer's performance but future re- search should consider attempting to measure it. If the basic premise ofthis study that ACT can enhance BST, con tinue to be born ov, then future esearch might attempt to enhance the effectiveness of BST in other areas for which AST is already sup ported, such as abduction prevention, gun-play prevention, as well as sexual sbuse prevention (Wiles & Willer, 2008). In addition, future researchers might try to identify skills and/or contexts in whieh BST has historically not been sufficiently effective, in order to evaluate whether adding ACT ean salvage the effectiveness of BST. I should be noted that the current soudy did not, however, messure improvements in the ae curacy of BST use, nor the efectivenes of BST used by the participants after the ACT condition induced them to use BST more frequently, Future research might also attempt to measure these outcomes ‘One potential limitation ofthe current study was the presence ofthe experimenter and experimenter expectancy during experimental ses- sions. ICs posible thatthe presence of the experimenter served as a prompt for the trainer participants to engage in behavioral sills training with the juniorlevel staff members. However, this potential limitation is present for most published staf taining studies that do not employ surreptitious observation (and few do). In order to minimize this potential limitation, the participants were not given feedback during the observation sessions in any condition of the study. ‘Additionally, e¢ described previously, the experimenter alway pos tioned herself in a way that she was not flly included inthe ongoing therapy sessions. I is also worth repeating that it was a regular part of the experimenter’ job to abserve the trainer participants inthe center in which the study was conducted, Pinally, the posible influence that reactivity may have had on the trainer participant behavior of im= plementing BST would likely have been present for the baseline and BST conditions, not only the ACT condition, and yet sill a substantial improvement was observed during the ACT condition. ‘An additional potential limitation isthe lack of a component ana- lysis regarding which components of ACT were necessary. The current [Th training inchuded exercises that focused on traning present mo- ‘ment, values, and committed action sls. In addition, the Willingness and Action Plan that was used at the end of the training atk the par- tcipant to identify challenging private events that they are willing to experience while chey engage in committed action, soit might be rea sonable to say that acceptance skills were briefly ouched on as wel, although they were not « focus ofthe training. A future component tnalysis could be conducted to determine which ofthe components of the traning were necessary. Prom the standpoint of baste behavioral processes, such a component analysis would be interesting and would be indine with Baer, Wolf, and Risley’ (1968) call for being both onceprally systematic and analyte. However, from 4 practical stand: ‘point, itis worth noting that the entire duration of the ACT workshop was 1 h, sot seems unlikely that there was a large amount of tn necessary intervention ‘The current study would also have been stronger if treatment in tegrity data were collected on the experimenters implementation of the Hh ACT «raining. The training followed exercises that are wel-doc mented in the ACT literature and fairly well protocolized. Stil, data ‘that diretly measure the experimenters implementation of ACT would make future research stronger. ‘An additonal potential limitation to the study is the possibility that some variable that i not central to ACT contributed tothe effectiveness ofthe ACT condition. For example, subsequent tothe I-h ACT trining and immediately before the next two observations, the experimenter Sent text message reminders to the participants to read over thei commited action plans, Given that the participants had written com mitments to engage in BST in their committed action plans, reading these plans could have functioned at a prompt to engage in BST. Its Uherefore posible that these text messages were functioning as ex perimenter proms to engage in BST and this could have contributed to the results, Although prompting per se is nota central component of ACT, an ACT teainer reminding @ trainee to revisit their own commit ments to valued action is by no means outside ofthe overall ACT model In addition, these texts were only sent on two occasions, soit seems unlikely that they, alone, were responsible fr the effects observed in ‘the ACT condition. Stil, since the study did not contain an ACT con- dition implemented without reminders, tis not possible to ule out entirely thatthe reminders functioned ae prompts end therefore con tributed tothe effectiveness of the intervention through prompting. ‘When researching an practicing ACT in the context of ABA, it i important to remain close toa functional analyte understanding ofthe procedures and the behavior changes they bring about. Tis is eis, both for maintaining philosophical and theoretical integrity with the defining element of ABA (Baer, Wol, Risley, 1968), but also because a functional analytic approach to language and cognition has always been {he foundation of ACT (ayes, 2008), Asis common in much previously published ACT Merature, no fnetional assessment was conducted in this study which then directly pointed to particular function-based procedures within the ACT training for trainers. Instead, the training was based on the general conceptual analysis that taining newly hired {taf almost inevitably involves aversive private events, a described in the behavioral conceptual analysis of ACT in the introduction. We at- tempted to make the training evaluated in the current study function ally relevant to participant behavior by identifying individualized va- ues for each trainer participant and discussing how specific committed setions may help lead the participant toward those values, In doing £0, the ACT training attempted to support behaviors that would result in augmented positive reinforcers in the context of training that were Unique to each individual parteipant, thereby attempting 0 approach cach participants behavior at functional level, Sill, future research should attempt to functionally astes each participants behavior with greater precision and te ACT taining procedures tothe results of those assessments more rigorously. A final potential limitation that warrants discussion is found in the operational definition ofthe dependent variable. Because an opport nity to implement 2ST was defined asthe trainer participant talking to the juniorlevel therapist about any aspect of their ARA implementa tion, not based an some other more objective evaluation of when an opportunity was really necessary clinically, i is possible that they im- plemented BST when it was not clinically necessary and/or they failed tw initiate any typeof interaction, when it would have been clinically beneficial. The rationale fr using this definition for opportunity is tha the true nature ofthe opportunity fora trainer to give feedback toa Juniorlevel therapist in realfe implementation of ABA services Is highly subtle and complex. During any given 20-min therapy period, there were at Teast 20-30 diferent programs the therapist could