Functional Communication Training (FCT) is an intervention that involves teaching a communicative response to decrease the occurrence of challenging behavior in individuals with disabilities. FCT is a two step intervention in which the interventionist first determines the function, or purpose, of the challenging behavior and then teaches a communicative response that will provide the same function as the challenging behavior. This meta-analysis addressed the following questions: (a) Is FCT more effective with a complete or brief functional analysis? (b) Is FCT differentially more effective for one communication mode versus another (unaided augmentative and alternative communication, aided augmentative and alternative communication, or verbal)? (c) Is FCT more effective when implemented in natural or contrived contexts? (d) Is FCT more effective for different functions of challenging behavior (attention, tangible, escape and multiple)? (e) How effective is FCT with individuals with challenging behavior, across different age ranges? (f) How effective is FCT with individuals with challenging behavior, across different disability categories? A thorough search was performed to find all articles related to FCT. The articles were then reviewed to ensure that they met the inclusion criteria. Data were extracted from the graphs within each study and then analyzed using Robust Improvement Rate Difference (IRD). Forest plots were also created to aid in visual analysis to determine statistical significance and consistency of the results. A variable was determined to moderate the effectiveness of FCT if there was a statistically significant difference between the levels within each variable. Thirty nine studies were included in this meta-analysis. Over-all FCT has a Robust IRD score of .86 (confidence intervals = .85 - .87). Based on the findings of this meta-analysis FCT is most effective with brief functional analysis and verbal communication. FCT was equally effective in natural and contrived settings. FCT appears to be most effective when an individual's behavior serves as attention seeking or an attempt to gain access to a tangible item. FCT appears to be more effective with school age individuals rather than adults. Finally, FCT may be more effective with individuals with autism spectrum disorder than intellectual disabilities or other disabilities.

The current study evaluated the effectiveness of delivering behavioral assessment and treatment to reduce challenging behavior shown by Korean children with ASD by using in-home telehealth from the U.S. The participants were five young children diagnosed with autism who lived in Korea and displayed challenging behavior. The children’s mothers, who had no previous experience in functional analysis (FA) and functional communication training (FCT) procedures, implemented all procedures with coaching provided by a behavior consultant during assessment and treatment sessions via telehealth. The results of the current study showed that functional analyses conducted via telehealth from the U.S. to the children’s homes in Korea were effective in identifying the function of challenging behavior for each participant. Furthermore, the results also showed that challenging behavior was reduced by 100% across all children by the end of treatment. These results suggest that telehealth can be an effective and efficient way to deliver behavior analytic services for underserved populations in countries like Korea.

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This study deals with the following question': "Who is most 'trainable' as an effective empathic communicator?" In the process it will attempt to determine if self-concept is significantly correlated with communicative ability, specifically the ability to respond empathically to others. Measurement of self-concept will employ the Tennessee Self Vie Scale which will be administered to the members of an undergraduate speech course, Speech 360. Tests measuring the levels of empathic discrimination and empathic communication will be given to the same population in determining empathic communicative ability scores.

Individuals with intellectual and developmental disabilities, such as Autism Spectrum Disorder, often engage in challenging behavior that severely limits positive outcomes. Although treatment packages comprising functional communication training and multiple schedules of reinforcement have demonstrated great promise to both increase appropriate, socially acceptable communication responses for preferred items and decrease challenging behavior associated with not having access to preferred items, resurgence of challenging behavior has been reported to occur during lengthy periods when preferred items are not available (i.e., extinction). This study evaluated whether noncontingent access to an alternative item during an abrupt shift to a lengthy period of extinction would reduce the extent of challenging behavior. Two children with Autism Spectrum Disorder participated. The results of this study indicated that (a) functional communication training successfully reduced challenging behavior and increased the rate of functional communication responses (FCR) for both participants, (b) multiple schedules of reinforcement (i.e., signaled periods of reinforcement and extinction for FCRs) successfully produced discriminated FCRs, and (c) no major differences in challenging behavior were observed when alternative items were presented during the abrupt shift to a terminal period of extinction versus when alternative items were not presented. Limitations and future directions of research are discussed.

Fibromyalgia syndrome (FMS) is a debilitating condition that affects millions of individuals throughout the world. As of yet the specific etiology of this condition remains unknown and successful treatments remain in their infancy. Although several studies have focused on the emotional components of fibromyalgia, none have specifically addressed the issues of communication and anger that appear to be important among this patient population. The objectives of this study were to design a 4-week experimental group therapy treatment based on successful cognitive behavioral components and add anger management and communication components in an attempt to increase benefits to the overall well-being of patients. Subjects were 46 fibromyalgia patients recruited from physicians, chiropractors, and physical therapists as well as through newspaper, radio, and advertising through flyers. Patients who were accepted into the study were randomly assigned to either a treatment group or a wait-list control group, with the control group receiving the treatment in the month following the treatment group. Outcomes were assessed using a repeated measures analysis of variance with one within (time) and one-between subjects (group) factor. The five assessment measures utilized in this study were the Fibromyalgia Impact Questionnaire (FIQ), the Short-Form 36 (SF-36) Version 2, the Chronic Pain Self-Efficacy Survey (CPSS), the State Trait Anger Expression Inventory- 2 (ST AXI-2) and a communication inventory developed specifically for this intervention. Specific outcomes measured included change on fibromyalgia-specific symptoms and physical and emotional health-related status, improvement in communication, change in anger scores, and changes in levels of self-efficacy. Analysis of patient outcome data revealed that significant results were achieved in the areas of mental health and communication variables . In addition, several notable effect sizes were also found, particularly in the areas of vitality (-.97), mental health (-.76) and pain management (-1.17). Results demonstrated that a brief, cost-effective 4-week intervention can have a beneficial impact for FMS patients in the area of psychological function. Implications of these findings are discussed within the context of the existing literature on fibromyalgia treatment as well as in terms of possible limitations of the study as it was conducted.

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Canadian national survey of oncology residency program directors and trainees; randomized trial of medical education intervention / Purpose: This work addresses teaching communication skills for eliciting cardiopulmonary resuscitation (CPR) wishes, or code status discussions, with cancer patients. The objectives of this thesis include: 1) define current teaching practices for code status communication training in Canadian oncology residency programs, and 2) examine the effect of teaching a novel communication framework for code status discussions to oncology residents. Methods: All current residents and program directors in Canadian medical and radiation oncology residency programs were surveyed regarding education, perceived gaps in training, attitudes towards and patterns of clinical practice for code status discussions with cancer patients. We carried out a multicentre randomized trial to determine the effect of teaching a code status communication framework to oncology learners. Residents completed a training workshop and were evaluated in simulated patient encounters (observed structured clinical exam [OSCE]). Participants were randomized to complete the training before the OSCE (experimental arm), or after the OSCE (control arm). The primary outcome was objective rating of code status communication skills. Results: Current postgraduate oncology curricula lack formal teaching and evaluation of code status communication skills. Educators support the need for innovative teaching tools in this field. Accordingly, a novel six-step communication framework was created in which core themes were summarized by the mnemonic acronym PULSES (Prognosis, Underlying values, Long-term outcome and Short-term outcome of CPR, provision of an Educated recommendation, Summary, style and documentation). A total of 46 oncology residents from 3 training centres participated in the randomized trial. Overall, learners in the experimental group had higher mean content-specific, general communication, and global rating communication scores than those in the control group. The training program conferred the greatest benefit among junior residents. Scores across rating tools were highly correlated. Conclusions: Communication training for code status discussions in Canadian oncology residency programs is lacking. With use of a novel communication framework, we have shown that structured teaching on code status discussions can improve competence in this challenging communication task. Moreover, we have developed educational resources that can be implemented in current curricula. Building capacity for clear and effective code status communication with cancer patients will contribute to high quality end of life care in Canada. / Thesis / Master of Science (MSc) / Medical learners in oncology (cancer care) training programs often lead discussions with cancer patients about code status, that is, patients’ wishes for use or non-use of life-sustaining resuscitation interventions including CPR. Learners receive little training for these complex encounters; yet, decisions regarding resuscitation wishes can influence the quality of care received by cancer patients at end of life. In this study we conducted a survey of trainees and program directors in Canada to better understand current educational practices and attitudes towards education on this topic. Most trainees are not receiving formal teaching or evaluation, and new educational resources are needed. We then developed a 6-step communication guide for code status discussions. We studied the effect of a training workshop in which the communication guide was taught to learners in oncology. We found that the training program improved communication ability among learners with the greatest impact seen among junior learners.

Individuals with brain injury are in need of speech and language therapy to improve impaired cognitive-communicative skills. Including significant communication partners (e.g., caregivers, spouses or parents) in intervention encourages carryover of skills practiced in therapy to natural communication contexts. Additionally, unimpaired partners benefit from training on how to communicate more effectively and and support the partner’s use of compensatory strategies for impaired cognitive skills. The objective of this multiple single case study was to evaluate the outcomes of a training program delivered to two dyads (Dyad B. and Dyad W.) composed of an adult with brain injury and an everyday communication partner. Participant dyads were recruited from a local brain injury support group. Training consisted of a four-week program during which participants received brain injury education, developed and monitored progress on goals, received instruction on communication strategies, and engaged in self-evaluation and role-play activities. Dependent variables were progress on individual goals, analysis of discourse variables, and the LaTrobe Communication Questionnaire. Treatment effects included a decrease in the amount of overlapping speech and an increase in the proportion of obliges and responses relative to comments for Dyad B., and increased deficit awareness and decreased conversation dominance on the part of the participant with brain injury for Dyad W. Results of the study showed that communication dyads affected by brain injury benefit from short-term training provided to both partners. / text

This study examines the design, implementation and evaluation of a communication skills training programme for adherence counsellors in a paediatric HIV clinic. Effective communication is a pre-requisite skill for any counselling interaction. For both prevention and treatment, counselling is a critical component of the healthcare team response to the HIV epidemic. Given the shortages of healthcare workers in sub-Saharan Africa, task-shifting of the counselling role to less-trained cadres of workers is commonplace. In the multilingual, multicultural South African context, taskshifting coupled with the complexity of the message in paediatric HIV presents enormous challenges. In-service support for counsellors is lacking. Counsellor burn-out and fatigue is commonplace affecting the quality of counselling interactions. Measuring the quality of communication in a multilingual context poses ethical and methodological challenges and is a neglected area of research. Traditional communication and counselling assessments appear to be largely taxonomic; lack cultural and linguistic sensitivity; and fail to acknowledge communication as a dynamic, two-way process. Mindful of these issues, this study utilized a non-taxonomic approach. Verbal and non-verbal communication was analysed before and after the implementation of in-service training which was tailored to the specific research context. The training comprised a two day multidisciplinary team workshop followed by individual training. This consisted of video feedback and analysis of counsellors’ own sessions and was attended by four counsellors. Results were recorded over an eighteen month period. Twenty-two consultations between counsellors and caregivers were video-recorded, transcribed verbatim and analysed using a hybridized form of linguistic analysis. Findings that demonstrated consensus, substantiation and cross-consultation occurrence were triangulated with thematically analysed interview data, patient questionnaires and researcher reflections. These methods are more sensitive to process than checklist approaches and individualised, complex dynamics emerged. Communication barriers and facilitators were identified before training. Variations in communicative competence between counsellors appeared to be unrelated to prior training. After training, counsellors asked more open-ended questions, encouraged caregivers more, provided simpler explanations of treatment regimens and checked understanding more effectively. In response, caregivers initiated more questions. These findings suggest that communication training improves treatment literacy and results in interactions that are more patient-centered. Despite this evidence, the results suggest limitations to the impact of communication training given the lack of agency of women in South Africa. Interactions included frank and open discussion about cultural beliefs. However, this benefit may be lost due to poor healthcare team cohesion. In their roles as mothers and caregivers themselves, counsellors are effective patient advocates and bring their own lifeworld experience to the counselling interaction. These shared stories are testimonies to the resilience of women living in poverty. Whilst allowing for greater exploration of patients’ cultural beliefs and explanatory models, communication training has limited impact in assisting counsellors with dealing with issues such as disclosure, non-adherence and scepticism about biomedicine. Results indicate conflict between patient-centeredness and perceived desired medical outcomes. Caregivers and counsellors appeared to engage in ritualistic dialogue when discussing certain topics suggesting that a shared lifeworld between caregiver and counsellor is insufficient to overcome barriers from the meso (institutional) and macro (broader socio-political) context. An awareness of the impact of context is critical to our understanding of communication in a clinical setting. The results from this research have implications for the role of the counsellor within a multidisciplinary team and establish a need for communication specialists to work in a clinical setting within the HIV epidemic.