Ludzkie koronawirusy - autor: Krzysztof Pyrć z Zakładu Mikrobiologii, Wydział Biochemii, Biofizyki i Biotechnologii, Uniwersytet Jagielloński, Kraków

Zastanawiasz się, jak wydać pracę doktorską, habilitacyjną lub monografię? Chcesz dokonać zmian w stylistyce i interpunkcji tekstu naukowego? Nic prostszego! Zaufaj Wydawnictwu Borgis – wydawcy renomowanych książek i czasopism medycznych. Zapewniamy przede wszystkim profesjonalne wsparcie w przygotowaniu pracy, opracowanie dokumentacji oraz druk pracy doktorskiej, magisterskiej, habilitacyjnej. Dzięki nam nie będziesz musiał zajmować się projektowaniem okładki oraz typografią książki.

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© Borgis - Postępy Nauk Medycznych 1/2013, s. 79-84
*Linda S. Heitzman-Powell1, Rachel White2, Phillip Tafs3, Jay Buzhardt4
Wykorzystywanie technologii nauczania dystansowego w czasie szkolenia klinicystów do pracy z dziećmi z autyzmem: Model OASIS
Towards a Technology of Supervision: Use of the OASIS Model in the Delivery of Distance Supervision
1 Center for Child Health and Development, University of Kansas Medical Center, USA
Head of Department: R. Matthew Reese, PhD
2Integrated Behavioral Technologies, Inc., USA
Head: Linda S. Heitzman-Powell, PhD
3 Center for Human Development, University of Alaska, USA
Head: Karen Ward, EdD
4 Juniper Gardens Children’s Project, University of Kansas, USA
Head of Department: Charles R. Greenwood, PhD
Streszczenie
Superwizja studentów i profesjonalistów zdobywających doświadczenie w nowym zawodzie jest standardową praktyką w wielu dziedzinach. W środowisku psychologów behawioralnych, Rada Certyfikacyjna Analityków Zachowania (Behavior Analyst Certification Board® – BACB) powołała ostatnio grupę roboczą mającą za zadanie ocenić sposoby przeprowadzania superwizji (1). Do celów grupy roboczej należą: określenie „(a) lepiej zdefiniowanych aktywności mogących być uznanymi jako „doświadczenie praktyczne”, (b) kwalifikacji superwizorów, (c) wytycznych dotyczących formatu superwizji” (1, str. 1). Istniejący obecnie brak badań i opracowanej technologii przeprowadzania wysokiej jakości superwizji może stanowić zagrożenie prawne dla całej dyscypliny. Impulsem do wykonania opisywanego eksperymentu był coraz to większy popyt na świadczenia w zakresie analizy zachowania i wiążąca się z tym konieczność kształcenia osób do poprawnego stosowania technik behawioralnych. Program szkoleniowy był tworzony w dwóch etapach: 1) uspójnienie z obecnie istniejącym kursem treningowym, który już odpowiada standardom BACB i 2) modyfikacja programu w celu przeprowadzania nauczania dystansowego. Ogólne wyniki są pozytywne, ponieważ osoby uczące się uzyskały wzrost wiedzy i umiejętności w czasie uczestnictwa w programie szkoleniowym. Odsetek osób zaliczających testy był większy niż procent osób zdających egzamin certyfikacyjny przygotowany przez BACB.
Summary
The supervision of students and professionals learning a new trade is standard practice in professional fields. In the behavior analytic community, Behavior Analyst Certification Board ® (BACB) has recently developed a Supervision Task Force to examine supervision practices (1). This task force is focused on establishing “(a) more clearly defined approved experience activities, (b) supervisor qualification, and (c) guidelines for the format of supervision” (1, p.1). The current lack of research and appropriate technologies for consistent, high quality supervision is a potential liability for the field as a whole. The current project was developed in response to the significant increase in demand for behavior analytic services and the corresponding need to increase providers well trained in best practice, techniques. The training was developed in 2 phases: 1) coordination with an existing distance-program that had acknowledgement as meeting the course sequence of the BACB®, and 2) modification of an existing training and supervision program that could be delivered via remote/ /distance technology. General outcomes are positive with trainees increasing in both knowledge and skill application from entry into the distance supervision program until successfully exiting the program. Pass rates for trainees participating in the distance supervision program were higher than those reported by the Behavior Analyst Certification Board for the past exam cycle.
INTRODUCTION
The supervision of students and professionals learning a new trade is a long established tradition with roots as far back as the ancient Greeks and is recognized in the Hippocratic oath (2). As a relatively new credentialing program, effective supervision practices have been a concern for the behavior analytic community and in 2011 the Behavior Analyst Certification Board® (BACB®) developed a Supervision Task Force (1). This task force is focused on establishing “(a) more clearly defined approved experience activities, (b) supervisor qualification, and (c) guidelines for the format of supervision” (1, p.1). Despite this discussion there is limited research or guidance on best practice in supervision of behavior analysts. Lack of research and appropriate technologies for consistent, high quality supervision is a potential liability for the field as a whole.
The creation of the BACB certification process has led to the availability of practitioners who have demonstrated knowledge in core outcome areas that are related to evidence based practice and data based decision making (www.bacb.com). These practitioners’ (Board Certified Behavior Analysts – BCBA) use of data driven techniques have led to better dissemination of evidence-based practices in fields such as special education and autism intervention. The practice of making data-based decisions has led to increased demand for BCBA services, particularly for autism therapy, resulting in increases in funding streams (3). As the demand for services has increased so has the number of candidates taking the certification exam (BACB, 2012). This, by definition, has resulted in increased demand for supervision.
However, having advanced training as a BCBA or other clinical personnel is no guarantee one is able to effectively transfer both knowledge and skill to those they are supervising (4). The consequences of an unsuitable BCBA supervisory experience can lead to a deficiency in both demonstrated knowledge in core outcome areas and related use of evidence-based practices. The result of this could be far-reaching as a poorly supervised BCBA goes on to perpetuate the supervisory experience with other, upcoming, professionals. Behavior analysis has incorporated technology since its inception (5). In their seminal article, Baer, Wolf, and Risley described a “rule of thumb” for evaluating the technological aspects of a procedure as appropriate if “typically trained reader could replicate that procedure well enough to produce the same results”. Currently there is little research on procedures of effective supervision for even well trained BCBA’s to replicate. The creation of a technology for guiding the format of supervision is an important next step for not only increasing the consistency of experiences for BCBA’s, but also for maintaining quality in the field.
Recently, Redmon (6) discussed the need for the adoption of behavioral technologies at a system level, stating most strategies were neither analytic nor well defined and that “Some individuals are effective... some are not, little analytic work is available to explain the difference” (p. 441). This challenge pertains to our current state of affairs in the behavior analytic community with regards to producing qualified BCBA’s: some are good at supervision while others are not and there is currently no body of research to explain, or quantify, the difference. An increase in BCBA candidates increases the need for a technology to bridge the gap between academic experience and independence, outlining differences between good and poor supervision, thus setting a “standard” for the supervisory experience.
This discussion must also grapple with the explosion of distance options now available for behavior analytic training and to address the needs of individuals living in geographically remote areas. Approximately 50% of the lower 48 states are rural, with close to 20% of the US population, or over 53 million US citizens living in these rural areas (7). Key to the behavior analytic community is the international dissemination of the BCBA credential: world-wide 50% of the population resides in rural communities (United Nations, 2007). In many remote areas travel to and from appropriate training sites can be difficult and in response the use of distance technology has increased. Distance delivered education has potential to be an effective model for the dissemination of BCBA University training. The BACB® reports a similar pass rate for distance students compared to traditional students when taking the certification test for BCBA’s (1). Students who are studying at a distance often do not have access to onsite, traditional supervision and must look to distance supervision as their only option. The nature of distance supervision makes the need for distance technology and structure paramount.
One distance training program, the Online and Applied System for Intervention Skills (OASIS) provides a structure to address the training needs of those living outside urban areas. The original version of this model used components of distance technology (online education) to train community-based providers working in homes with children and youth with ASD (8, 9). In 2005 the OASIS training was modified for use by parents of children with ASD in rural and remote areas with similar success, creating a training structure that was delivered entirely using distance technology (10). Use of the OASIS model provides a vehicle for the dissemination of a structured experience for professionals living in non-urban areas who are actively seeking professional supervision.
When looking at the foundations of behavior analysis (5) there is an obvious need for a more structured technological approach to ensure BCBA’s have appropriate skills to practice effectively in the community. The following project was a partnership between two predominantly rural regions, used an iteration of the OASIS model to provide students in a geographically remote area access to BCBA’s, and was developed in response to the significant increase in ASD and the need to increase providers well trained in best practice techniques.
METHODS
Development
The program was developed in 2 phases: 1) coordination with an existing distance-program that met the course sequence requirements of the BACB®, and 2) modification of an existing training and supervision program that could be delivered via remote/distance technology. This program reflects the BACB® requirements for the Independent Field Supervision including 1500 hours of field experience and a minimum of 75 hrs of direct supervision time. It was anticipated that trainees would take a minimum of 24 months to complete the requirements of the program and the BACB. In order to better structure the pace and ensure appropriate content was covered, a supervision manual with 17 topics was used. Each topic had a series of informational content based on current literature and included an ethics discussion as well as written assignments directly tied to the content of the monthly topic. Direct contact with supervisors occurred, at minimum, every other week. All supervision sessions (group and individual) we completed via video conference. Supervisors traveled on a bi-monthly basis to complete on-site face-to-face supervision as well as to complete fidelity checklists on supervisee skills.
Recruitment and Participant Information
Participants were recruited through online announcements and word of mouth. Trainees had to apply to and be accepted into a distance BACB® approved university course, and were required to complete an online application for funding support. Of the trainees accepted into the program for Cohorts 1 and 2, 25% held a Master’s degree in Education, 30% in Early Childhood, 30% in Social Work, and 17% in Psychology/Other. Seventy-five percent of trainees were female; 25% were male (tab. 1).
Table 1. Trainee Demographics Cohorts 1 and 2.
 Academic DegreeGender
EducationEarly ChildhoPsychologySocial WorkOtherF
N332329
Percent25%30%17%30%17%75%
Note: Numbers do not equal 100% due to some students reporting more than 1 degree.
Field Experience
All trainees in the program were full-time employees in addition to their student status. The majority of field experience was accumulated in the context of their current employment. Additional field placements were identified for Cohort 1 members whose employment did not allow for direct access to clients. Later cohorts were required to participate in early intensive behavior interventions with clients with ASD served by the program.
Setting
Trainees were all residents of Alaska; Supervisors were located in Kansas. Trainees used an online “home”, or learning management system, to interact with supervisors, access the 17 topics, assignments, and discussion boards, and submit assignments and receive feedback.
Materials
Program Guide
A Program Guide was modified based on the previous work of Heitzman-Powell (9) as a text for trainees. The researchers used the BACB® task list, the University course syllabi, and their own experience as professionals to create a sequence of 17 topics that corresponded to the course (topics available upon request). A new topic was presented at each group supervision meeting. Each topic contained objectives and definitions, narrative text based on current literature, and assignments. Additional information was presented in group supervision sessions, including examples and practice opportunities.
Procedures
Assignments
Assignments consisted of three to twelve questions regarding information contained in the Program Guide. Trainees were required to submit written responses for each assignment. Assignments included items such as the creation of operational definitions, writing programs, creating data collection systems, and constructing behavior intervention plans. Documents were submitted via email or through an online course site. Assignments were collected to satisfy exit criteria and gave trainees reference materials for later use.
Online Discussion Board
Prior to each group supervision, trainees were required to initiate 2 posts with questions or comments based on the current topic and respond to at least 2 of their peers’ posts. Supervisors used points from within the discussion to guide group supervision.
Distance Group Supervision

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Piśmiennictwo
1. Behavior Analyst Certification Board. (September, 2011). Behavior Analyst Online Newsletter. Retrieved 8/23/2012 from http://www.bacb.com/newsletter/BACB_Newsletter_9-9-11.pdf
2. Milne D: Evidence-Based Clinical Supervision: Principles and Practice. Blackwell Publishing Ltd., Oxford, UK 2009; retrieved 8/24/2012 from http://media.wiley.com/product_data/excerpt/92/14051584/1405158492.pdf
3. Autism Speaks In: Autism Votes 2012; retrieved 8/23/12 from http://www.autismvotes.org/site/c.frKNI3PCImE/b.3909861/k.B9DF/State_Initiatives.htm
4. Martin FA, Cannon WC: The necessity of a philosophy of clinical supervision. 2010; retrieved 8/28/2012 from http://counselingoutfitters.com/vistas/vistas10/Article_45.pdf
5. Baer DM, Wolf MM, Risley TR: Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis 1968; 1: 1-97.
6. Redmon WK: Pinpointing the technological fault in applied behavior analysis. Journal of Applied Behavior Analysis 1991; 24: 441-4.
7. United States Department of Agriculture. Economic Research Service 2012; retrieved 8/27/12 from http://www.ers.usda.gov/topics/rural-economy-population/population-migration.aspx
8. Heitzman-Powell L, Buzhardt J, Suchowierska M, Morrison K: Behavioral Aide Training Program [Online]. McLouth 2003; KS: Integrated Behavioral Technologies, Inc. Available: http://www.ibt-inc.org
9. Buzhardt J, Heitzman-Powell L: Training Behavioral Aides with a Combination of Online and Face-to-Face Procedures. Teaching Exceptional Children 2005; 37: 20-6.
10. Heitzman-Powell L, Buzhardt J, Rusinko L, Miller T: Formative Evaluation of an ABA Outreach Training Program for Parents of Children with Autism in Remote Areas. Focus on Autism and Other Developmental Disabilities (under review July 2012).
11. Schwartz I, Baer DM: Social validity assessments: is current practice state of the art? Journal of Applied Behavior Analysis 1991; 24: 189-204.
12. Wolf M: Social validity: The case for subjective measurement or how applied behavior analysis is finding its heart. Journal of Applied Behavior Analysis 1978; 11: 203-214.
otrzymano: 2012-11-07
zaakceptowano do druku: 2012-12-17

Adres do korespondencji:
*Linda S. Heitzman-Powell
3901 Rainbow Blvd. Mailstop 4003
Kansas City, KS 66160
tel.: (0-01) 913-945-6604, fax: (0-01) 913-588-5916
e-mail: lhpowell@ku.edu

Postępy Nauk Medycznych 1/2013
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