TEACHING YOUNG ADULTS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES HOW TO RECOGNIZE AND RESPOND TO COWORKER VICTIMIZATION SCENARIOS By Andrea M. Peterson A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of Applied Behavior Analysis—Master of Arts 2020 ABSTRACT TEACHING YOUNG ADULTS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES HOW TO RECOGNIZE AND RESPOND TO COWORKER VICTIMIZATION SCENARIOS By Andrea M. Peterson Adults with intellectual and developmental disabilities (IDD) are at risk of experiencing social victimization and should be taught to respond to deceptive statements and victimization scenarios they are likely to encounter as they transition from school to work. Using a multiple probe across participants design, the current study evaluated the effectiveness of behavioral skills with multiple exemplar training (BS+MET) to teach four young adults with IDD a response to victimization protocol. Participants were taught to 1) abstain from retaliation, 2) decline the request, 3) respond with an acknowledgment that the person is attempting to victimize them, and 4) walk or turn away. Two participants demonstrated mastery of this response after only BS+MET, while the other two participants demonstrated mastery of the response after BS+MET and additional in situ training (IST). Additionally, three of the four participants demonstrated generalization across settings, across exemplars, and with coworkers, and they maintained the response up to two-months after the completion of training. This study expands research of BS+MET and IST to teach safety skills to adults with IDD and provides insights into how to improve generalization of skills taught through behavioral skills training. Implications for further research are discussed. Keywords: behavioral skills training, multiple exemplar training, workplace victimization, intellectual and developmental disabilities iii TABLE OF CONTENTS LIST OF TABLES ..........................................................................................................................v LIST OF FIGURES .......................................................................................................................vi KEY TO SYMBOLS AND ABBREVIATIONS .........................................................................vii Introduction .....................................................................................................................................1 Victimization Prevention Skills .................................................................................................3 Method ............................................................................................................................................8 Participants .................................................................................................................................8 Adults with IDD ....................................................................................................................8 Confederates .........................................................................................................................8 Setting and Materials ........................................................................................................…......9 Dependent Variable ..........................................................................................................…......9 Abstaining from retaliation. .......................................................................................…....10 Declining the request. ................................................................................................…....10 Acknowledging victimization. ...................................................................................…....10 Walking or turning away. .........................................................................................…....11 Response Measurement ....................................................................................................…....11 Interobserver agreement (IOA). ................................................................................…....12 Experimental Design .........................................................................................................…....13 Procedures .................................................................................................................................13 Victimization statement development. ..............................................................................13 In situ probes. ....................................................................................................................15 BS+MET. ...........................................................................................................................16 Post-training. ...... ...............................................................................................................17 IST. ....................................................................................................................................17 Follow-up. ..........................................................................................................................17 Coworker probes. ...............................................................................................................18 Generalization. ...................................................................................................................19 Procedural Fidelity. ....................................................................................................................19 Data Analysis ............................................................................................................................20 Results. ...........................................................................................................................................21 Ben ............................................................................................................................................21 Kyle ...........................................................................................................................................22 Ella ............................................................................................................................................23 Zev ............................................................................................................................................23 Discussion. .....................................................................................................................................24 Limitations and Future Research ..............................................................................................27 iii Conclusion ................................................................................................................................29 APPENDIX ....................................................................................................................................31 REFERENCES ..............................................................................................................................36 iv LIST OF TABLES Table 1: Scoring Guide for In Situ Probes. ....................................................................................33 Table 2: Timeline and Information for Each Phase of Study. ........................................................34 v LIST OF FIGURES Figure 1: Results of Performance During In Situ Probes for Ben, Kyle, Ella, and Zev. ..............34 vi KEY TO SYMBOLS AND ABBREVIATIONS ADHD Attention deficit hyperactivity disorder ASD Autism Spectrum Disorder BS+MET Behavior skills with multiple exemplar training BST IDD IST IOA MET Behavioral skills training Intellectual and developmental disabilities In situ training Interobserver agreement Multiple exemplar training vii Introduction Individuals with intellectual and developmental disabilities (IDD) are at least twice as likely than neurotypical adults to experience victimization (i.e., crimes that single out an individual or household (Bureau of Justice Statistics, 2019; Harrell, 2017)). This victimization has been reported to occur across their lifespan and to take several forms, such as hate and violent crimes (Casteel, Martin, Smith, Gurka, & Kupper, 2008; Harrel, 2017; Martin et al., 2006; Rand & Harrel, 2009; Thomas, Nixon, Ogloff, & Daffern, 2019), assault and robbery (Fisher, Baird, Currey, & Hodapp, 2016), as well as subtler forms, including mate crimes and microaggressions (Fevre, Robinson, Lewis, & Jones, 2013; Landman, 2014). Alarmingly, most victims with IDD know the perpetrator; Harrell (2017) reported that from 2011 to 2015, well- known or casual acquaintances of individuals with IDD accounted for 40% of the perpetrators of nonfatal crimes against persons with disabilities. These staggering rates highlight the need to teach individuals with IDD to recognize and appropriately respond to potential victimization scenarios presented by individuals they know. Two lesser detectable types of victimization individuals with IDD may be more likely to experience are mate crimes and microaggressions. Mate crimes were first described by Landman (2014) and the Safety Net Project (2013) to raise awareness of the phenomenon in which people with IDD were being befriended and then exploited by individuals posing to be “friends” or “mates.” Mate crimes do not start as abuse; rather, through the process of grooming, the perpetrator obtains access to the individual (e.g., befriends), acquires the individual’s compliance, and maintains the trust of the individual so that the perpetrator avoids disclosure (Craven, Brown, & Gilchrist, 2006). As perpetrators of mate crimes increasingly groom the 1 individual with IDD, the crimes committed by the perpetrator tend to repeat and worsen in severity with each instance (Landman, 2014). Mate crimes can range in severity from severe hate crimes to less obvious, subtler forms of victimization. Less discrete forms of reported mate crimes include being touched inappropriately, being physically assaulted, being belittled or shamed by others, and being harassed electronically or over text messaging (Fisher, Moskowitz, & Hodapp, 2012; Landman, 2014; Partington & Mueller, 2012). Alternatively, mate crimes that are more discrete include the individual with IDD being called unwanted names, being excluded from group activities, being convinced to lend money or valuables to others without the promise of getting it back, and being ignored by others. Mate crimes are similar to subtle instances of victimization called microaggressions, that have been recently identified in the literature to occur in the workplace for individuals with IDD (Park, 2017). Microaggressions are defined as intentional or unintentional everyday occurrences of verbal, nonverbal, and environmental insults that communicate denigrating messages to individuals because of their race, culture, disability, or sexual orientation (National Institutes of Health, 2016; Sue et al., 2007; Park, 2017). There are three different types of microaggressions, including (1) microassaults (explicit verbal or nonverbal aggressions intended to hurt the victim); (2) microinsults (insults that are usually unconscious by the perpetrator that convey insensitivity towards the victim); and (3) microinvalidations (verbal statements or nonverbal actions that exclude the victim’s thoughts and feelings or exclude the victim from experiences) (National Institutes of Health, 2016). Research has recently reported that individuals with disabilities are at risk of experiencing microaggressions in the workplace (Park, 2017). For example, Fevre and 2 colleagues (2013) suggested that individuals with IDD are more likely than their neurotypical peers to experience ill-treatment in the workplace. Fevre et al.’s findings also suggest that if the employees with IDD attempt to escape the ill-treatment they face at work, it may result in their marginalization into less productive jobs, or even in their withdrawal from the workforce altogether. Victimization in the form of mate crimes and microaggressions may be more likely to occur in workplace settings (Fevre et al., 2013; Harrell, 2011; Park, 2017) because the individual with IDD is more likely to work alone or to receive less supervision. Further, perpetrators of victimization, specifically mate crimes, can be any person, including coworkers and direct supervisors of the individual with IDD. The attitudes of coworkers without disabilities toward those with IDD may also increase the likelihood of microaggressions. Meager and Higgins (2011) reported that many employers have biased opinions of employees with IDD, including the view that people with IDD are less productive than their neurotypical peers and that they will need more support to learn and perform their job. Such attitudes and biases add to the increased risk of victimization of individuals with IDD in the workplace. In fact, negative stereotypes of employees with IDD may result in reactions expressed in the form of microaggressions or mate crimes such as disgust, pity, or discomfort towards the employee with IDD that would not be experienced if an employee without IDD was hired instead (Sigmon & Edmunds, 2000). Victimization Prevention Skills Consequences of victimization for individuals with IDD are often moderate to severe, with some forms being life-threatening. Victims of mate crimes report a lower quality of life and self-esteem, experience anxiety, depression, and sleep difficulties, and may be prone to display aggressive behaviors; these negative effects make a long lasting, negative impact on the 3 individual’s mental health (Landman, 2014; McGrath, Jones, & Hastings, 2010). Certain mate crimes and violent forms of victimization have even led to the death, sexual assault, physical assault, or imprisonment of the victim with a disability (Landman, 2014). To prevent these negative consequences and to maintain the safety of individuals with IDD, programs that teach individuals with IDD the skills to prevent victimization through recognition and appropriate responding are needed. One approach to teach victimization prevention is to use behavioral skills training (BST) to teach individuals with IDD to recognize and respond to victimization. BST is a behavior analytic teaching strategy that has been effectively used to teach a variety of safety skills to individuals with and without disabilities, including teaching individuals with IDD to respond to bullying (Stannis, Crosland, Miltenberger, & Valbuena, 2019) and to abduction lures (Fisher, Burke, & Griffin, 2013; Sanchez & Miltenberger, 2015), as well as teaching neurotypical children safety skills such as response to abduction (Poche, Yoder, & Miltenberger, 1988), firearms (Miltenberger et al., 2004), and poison hazards (Dancho, Thompson, & Rhoades, 2008). BST consists of four steps – instructions, modeling, rehearsal, and feedback. The instructions phase of BST consists of the trainer providing a specific description of the behavior or skill being taught and why the behavior is important to the learner. During the modeling phase of BST, the trainer demonstrates the correct behavior for the learner. With this, the correct behavior is modeled either directly by the trainer or through a video model. After instructions and modeling are completed, the learner is given the opportunity to practice the correct behavior during the rehearsal phase of BST. After this rehearsal, the trainer provides immediate feedback of the learner’s performance, consisting of praise for correct performance of the behavior or parts 4 of the behavior, correction on errors emitted during the rehearsal, and instructions on how to improve the performance (Miltenberger, 2012). In conjunction with BST, in situ assessments are conducted to assess performance of the target (correct) behavior in the natural setting. For these assessments, confederates (individuals recruited by the trainer to pose as a perpetrator) are sometimes used to promote generalization of the target skill across people (Ledbetter-Cho et al., 2016; Leis & Reinerman-Jones, 2015; Odom, Hoyson, Jamieson, & Strain, 1985). If the learner does not perform the target behavior during the in situ assessment, the trainer then conducts in situ training (IST). To commence IST, the trainer or the confederate approaches the learner and delivers a lure. If the learner responds incorrectly, the trainer appears in the environment (if the lure was delivered by a confederate) and informs the learner they did not respond accurately. The learner is then asked to rehearse the target skill in that setting. IST is conducted to improve the likelihood that the target skill will be performed in the natural environment in the future (Miltenberger, 2012). Stannis et al. (2019) examined the effects of BST and IST to teach four adult men with intellectual disability to appropriately respond to bullying. Two of the four participants reached mastery criterion (100 percent accuracy displaying the 4 steps in the response to bullying protocol) after only exposure to BST; whereas, the remaining two participants required IST and still only acquired two to three of the response to bullying steps consistently. The results of Stannis et al. indicate that BST and IST may be effective procedures for some participants but that others might require additional teaching strategies to acquire the skills and to increase the likelihood of skill generalization. Multiple exemplar training (MET) may be one strategy that could be incorporated into BST to improve skill acquisition and generalization. MET is an instructional strategy in which 5 diverse stimuli and response topographies are used during training to promote skill acquisition and setting, situation, or response generalization (Cooper, Heron, & Heward, 2014). Ranick, Persicke, Tarbox, and Kornack (2013) used MET to teach three children with autism spectrum disorder (ASD) to recognize and respond to two types of deceptive statements. Specifically, during the participants’ regular in-home applied behavior analysis sessions, the authors presented the participants with two novel deceptive statements and at least two previously heard deceptive statements, ensuring the participants were continuously presented with novel exemplars. If the participants responded correctly to the deceptive statement (by identifying that they were wrong/a lie or blocked the deception from happening), the researcher provided social praise for the correct response. If the participants responded incorrectly to the deceptive statement, the researcher first prompted a correct response through asking leading questions. If the leading questions did not prompt the participant to emit a correct response, the researcher restated the deceptive statement and asked the participant whether it was true or not and why. Again if this did not prompt a correct response, the researcher told the participant the correct response and the reasoning as to why it was a deceptive statement. Through a multiple baseline across participants experimental design, the authors found that all participants acquired and maintained accurate responding to deceptive statements (i.e., the participant blocked the deceptive act of taking an object from the child or identified that the person was lying) through MET. Accurate responding to the deceptive statements maintained at a one-month follow-up probe. The results of Ranick et al. (2013) suggest that MET might also be an effective way to ensure generalization when teaching individuals with IDD to detect and respond to workplace victimization. Given findings from the previous research, BST with MET (BS + MET) may improve skill acquisition and increase response generalization. The current study extended previous 6 research to determine the effects of using BS+MET to teach young adults with IDD how to recognize and respond to subtle forms of workplace victimization. The specific research questions included: (1) does BS+MET increase accurate recognition and response to a victimization statement, as measured through responses in role-play scenarios; and (2) following BS+MET, do skills generalize to in situ probes of victimization statements in the employment setting delivered by both the trainer and a confederate coworker? 7 Participants Method Adults with IDD. Four participants (3 men, 1 woman) were recruited from two school- to-work transition programs in a city in the Midwest. Ben, a 19-year-old Caucasian male, was diagnosed with a specific learning disability, with secondary diagnoses of attention deficit hyperactivity disorder (ADHD), anxiety, and depression. Kyle, a 19-year old Asian male, was diagnosed with a hearing impairment with a secondary diagnosis of intellectual disability. Ella, a 19-year-old Caucasian female, was diagnosed with intellectual disability. Zev, a 20-year-old Caucasian male, was diagnosed with ASD with secondary diagnoses of intellectual disability and ADHD. All participants met the school-based eligibility for special education services and had an active individualized education plan. Each participant had less than two years’ experience in paid employment and no previous training on responding to victimization. Each participant was their own guardian and voluntarily agreed to participate in the study. Criteria for exclusion included if the participant emitted all four steps of the dependent variable during 50% of the baseline probes, but this did not occur for any of the recruited participants. Participants were paid at a rate of ten dollars an hour for training. Confederates. Three confederates were recruited to deliver victimization statements during the coworker in situ probes. Confederates were neurotypical coworkers at the participant’s current internship worksite. More specifically, inclusion criteria for confederates included: (a) interacted with the participant at least once a week at work; (b) was willing to conduct a research probe; and (c) was willing to attend training on how to conduct a research probe. Confederates were compensated for their participation at a rate of ten dollars an hour. 8 Setting and Materials Training sessions occurred in the school-to-work transition program classroom and/or conference room, which were approximately 900 square feet in area. Only the researcher, the participant, and sometimes a research assistant were present during training procedures. In situ probes conducted during baseline, BS+MET, post-training, and follow-up phases were conducted either in the school-to-work transition program classroom or at one of the participants’ internship worksites. These internship worksites included cafeterias, convenience shops, janitorial work, maintenance work, landscaping, and various office settings. Each worksite varied in size and the number of individuals who occupied the space during the probes (e.g., a convenience shop may have been 1,500 square feet with 15 occupants or a cafeteria may have been 130,000 square feet with 2,000 occupants at the time of the in situ probe). To account for any difficulties with reading or comprehension, all participants were provided with visual aids during training sessions (Miltenberger, 2012). Visual aids included short descriptions for each step in the target behavior. No participant required pre-teaching to read the visual aids. Each session was documented via an iPad using the camera application so that the participant and the implementer could be seen in the frame throughout the entire training session. A data sheet was provided to observers and coders to ensure consistent data collection. Dependent Variable The dependent variable was the participants’ performance of the response to victimization statement in the context of a workplace. Examples from both the definitions provided by Stannis et al. (2019) and Ranick et al. (2013) were used to develop the four-step response to victimization. Specifically, appropriately responding to a victimization statement 9 was defined as (1) abstaining from retaliation, (2) declining the request, (3) acknowledging that the person is attempting to victimize them, and (4) walking or turning away. Abstaining from retaliation. Abstaining from retaliation was defined as any instance in which the participant refrained from vocal and physical responding for the duration of the victimization statement and response. Refraining from vocal responding included any instance in which the participant emitted no vocal sounds such as a scoff, gasp, crying, whining, sighing, or speaking or yelling words for the duration of the delivery of the victimization statement. This did not include instances in which the participant made involuntary noises such as sneezing, coughing, or yawning. Refraining from physical retaliation included any instance in which the participant emitted no violent physical contact with the other person such as grabbing, pushing, kicking, or punching for the duration of the delivery and response to the victimization statement. Declining the request. Declining the request was defined as any instance in which the participant vocally stated that they would not comply with what was being asked of them in the victimization statement. This may have included statements such as, “No,” “I’m not going to do that,” or “No thanks.” This did not include statements such as, “Okay,” “Sure,” or “Maybe later.” This also did not include any instances in which the participant did not emit a vocalization. Acknowledging victimization. Acknowledging that the person was trying to victimize the individual was defined as any instance in which the participant vocally stated that they are being taken advantage of or victimized or they indicated that the request was not appropriate in response to the victimization statement. This may have included statements such as, “That’s not right,” “You’re trying to take advantage of me,” “You’re being deceptive,” or “You don’t 10 actually need that.” This did not include statements such as, “Okay,” “No,” “Maybe next time,” or “Not right now.” Walking or turning away. Walking away or turning away was defined as any form of movement by the participant that separated the participant from the perpetrator by at least three steps or the participant turning their shoulders in any direction by 90 degrees or greater. Walking away was any instance in which the participant moved at least three steps from the individual who spoke the victimization statement within 10 s of the delivery of the victimization statement. Turning away consisted of any instance in which the participant turned their shoulders away from the individual who spoke the victimization statement by a minimum of 90 degrees within 10 s of the delivery of the victimization statement. This did not include instances in which the participant moved less than three steps away from the perpetrator, the perpetrator moved away from the participant, or the participant ended the conversation but did not walk nor turn away. Response Measurement During all training sessions and in situ probes, responding was scored on a 5-point scale (0 to 4). Because a participant could face disciplinary actions or be fired if they vocally or physically retaliated towards a coworker, any response in which the participant did not abstain from retaliation (irrespective of any other steps the participant performed) was scored as 0 (similar to Stannis et al., 2019). Because of the dangers associated with being victimized, any response in which the participant agreed to a request embedded within the victimization statement (implying that the participant could have been victimized) was scored as 0. If the participant abstained from retaliation or did not agree to the request, then scores of 1 through 4 were given to correspond with the number of steps the participant performed accurately. A score 11 of 4 indicated that the participant completed all four steps including (1) abstaining from retaliation, (2) declining the request, (3) acknowledging victimization, and (4) walking or turning away. All training sessions were recorded in their entirety using an iPad camera. In situ probes were recorded using an iPad camera (placed either out of sight of the participant or in a natural placement to record the probe, such as on a table nearby) when a research assistant was not available to be at the probe in-person. The scoring guide can be found in Table 1. Interobserver agreement (IOA). During BS+MET, the researcher acted as the primary observer of the number of steps performed correctly during role-play and a second independent observer viewed 50% (8 of 16) of the recordings of the role-plays and coded the participants’ performance. During in situ probes, the researcher served as the primary observer and a second independent observer viewed either a recording of the probe or observed the probe in-person for 44% (30 of 68) of the probes conducted across all phases. During the coworker probes, the confederate coworker served as the primary observer while the researcher served as a secondary observer. Observers recorded each occurrence or nonoccurrence of each step of the response to victimization for each probe. IOA was calculated by dividing the number of agreements per assessment by four (the total number of steps) and multiplying it by 100 to yield a percentage (Ledford & Gast, 2018). The average IOA for the role-plays conducted during BS+MET was 97.5% (ranging from 80% to 100%) and for the in situ probes was 100%. IOA for Ben, Kyle, and Zev’s role-play and in situ probes was 100%. IOA for Ella’s role-play averaged 90% (ranging from 80% to 100%) and during in situ probes was 100%. IOA for all three coworker probes (3 of 3) was 100%. 12 Experimental Design A multiple probe across participant design was used in the study. Multiple probe designs are a variation of multiple baseline designs in which intermittent probes are used during baseline rather than daily assessments. This is a particularly well-suited design when the skill sequence is unlikely to improve without the intervention occurring (Ledford & Gast, 2018). This design is also best to use when there is a need to reduce participant exposure to the baseline probes. Because the victimization statements are sensitive in nature due to them possibly having negative effects on the participant, a multiple probe design ensured unnecessary exposure to the victimization probes in the baseline phase did not occur (Ledford & Gast, 2018). Procedures Victimization statement development. To identify the most often experienced forms of victimization and to develop victimization statements, a survey was first designed and disseminated to assess workplace victimization experienced by adults with IDD. The Workplace Victimization Survey consisted of 42 questions for respondents to rate on a 4-point likert scale (0 = never to 3 = all the time (almost daily)). The questions, designed to assess interactions with coworkers and workplace culture, were derived from already existing measures of functional living skills (e.g., the Assessment of Functional Living Skills; Partington & Mueller, 2012) and from research highlighting specific types of mate crimes, microaggressions, and workplace victimization experienced by individuals with IDD (Einarsen, Hoel, & Notelaers, 2009; Landman, 2014; Lee & Brotheridge, 2006; McCarthy, 2017; Thomas, 2011). The survey was distributed to parents, caregivers, employers, and job support providers of adults with IDD because they are the individuals who interact daily with adults with IDD and would be most 13 likely to have a current knowledge of the interactions between the adult with IDD and his/her coworkers, even if the adult with IDD did not recognize the victimization. The results from 38 respondents of the survey were analyzed and the top three occurring categories of workplace victimization were identified, including: theft; treating adults with IDD as if they are children (also known as infantilization) or calling the individual with IDD by a childish pet name; and assuming the person with IDD is not able to do a work task because of their disability. These three categories of victimization were used to develop multiple victimization statements related to each form of victimization to be used during BS+MET and the in situ probes. Victimization statements were written to contain relatively the same difficulty of wording and so that each took approximately the same amount of time to state (were the same length). An example of a victimization statement pertaining to workplace theft was: “I lost my credit card. Can I use yours to buy my lunch?” An example of a victimization statement pertaining to treating an adult with IDD as if they are a child (via use of a pet name) was: “I’m the worst with names. I’m going to call you pal.” Lastly, an example of a victimization statement pertaining to assuming a worker with IDD cannot do a task because of their disability was: “You’ll get it next time, let me do [the task] for you.” Once written, four individuals familiar with adults with IDD in workplace settings reviewed and rated each statement for external validity and on how difficult it was to recognize as victimization. Specifically, they read each statement and then rated the statement for external validity by choosing an option from extremely appropriate, moderately appropriate, slightly appropriate, neither appropriate nor inappropriate, slightly inappropriate, moderately inappropriate, or extremely inappropriate as it related to the type of victimization it aimed to address (theft, infantilization, or assuming the person with IDD cannot complete a work task due to their disability). Only statements rated as 14 extremely appropriate or moderately appropriate by all raters were utilized in this study. Then, they ranked each statement on whether it was easy, medium, or difficult to recognize as victimization. From these ratings, statements that were miscategorized were removed and statements were ordered from easiest to hardest to recognize for training purposes. In situ probes. To assess skill acquisition and generalization outside the training setting, in situ probes were conducted in the classroom and in each participant’s internship setting during baseline, BS+MET, post-training, and follow-up. In situ probes were delivered by the researcher at a predetermined time during a classroom session or during the participant’s internship shift. To incorporate MET, a new victimization statement was randomly selected (via an online random number generator) based on type (3 types of victimization), level of difficulty (easy, medium, hard), and location (classroom or internship worksite) and delivered each time a probe was conducted. To conduct the probe, the researcher approached the participant and stated the victimization statement (e.g., “I need cash, will you give me some?”). If the participant agreed to the request, the researcher stated a predetermined phrase to terminate the interaction without obtaining the request (e.g., “Oh never mind, I remember where I left my wallet. I’ll go grab it.”). If the participant did not agree to the request, the researcher stated “okay” and changed the subject of the conversation or walked away. These probes occurred at different times throughout the day and in various locations, with 30% of probes in each phase (e.g., once every third baseline probe, once every third BS+MET session, etc.) occurring at the workplace. No differential consequences were provided based on the participants’ responses. A timeline for each phase and when the probes were conducted can be found in Table 2. No more than one probe was conducted each day (as to avoid unnecessary exposure to victimization) and each lasted no longer than 15 to 30 s. 15 BS+MET. Individual training consisted of BS+MET, which included four steps: giving instructions, in-vivo modeling, rehearsal, and immediate feedback (Miltenberger, 2012). This phase took place in either the school-to-work transition program’s classroom or a conference room. Based on BST procedures described by Miltenberger (2012), the more easily recognizable victimization statements were taught during the first training session and then more difficult statements were incorporated in later training sessions. This training approach increases the likelihood for participants to achieve success and to cooperate throughout the BS+MET procedures (Miltenberger, 2012). To incorporate MET into BST, different victimization statements were discussed and modeled during instruction, and the participants rehearsed responding to new victimization statements during each role-play. Thus, the participants were exposed to multiple, new examples of victimization statements (e.g., “May I borrow your car for the week? Mine died” or “Will you buy me a pack of cigarettes? I’m not 18”) throughout each BS+MET session. Each BS+MET session began with a PowerPoint presentation, which included instruction of the importance of appropriate responses to victimization statements, examples of victimization statements, and how to appropriately respond to a victimization statement (abstaining from retaliation, declining the request, acknowledging victimization, and walking or turning away). Visual aids were available to all participants during this phase. Next, the researcher and a research assistant modeled the response to victimization skill for the participant using a script of novel victimization statements. After the instruction and modeling was completed, each participant rehearsed the response to victimization steps in 5 role-play scenarios. During each rehearsal, the researcher presented the victimization statement and the participant practiced the four steps of the response 16 to victimization. If an error occurred during rehearsal, immediate feedback was provided, which included the researcher interrupting the response, modeling the correct response, and asking the participant to complete the step again. Further, immediately after rehearsal, feedback was given by praising a correct response and identifying steps that needed to be improved. Performance during role-plays was scored using the same response measurement system used to assess performance during the in situ probes. BS+MET sessions were conducted 3 to 5 times per week until mastery criterion was met during role-play; mastery criterion was as follows: the participant responded to a victimization statement with 100% accuracy for four out of five (80%) role-plays for three consecutive BS+MET sessions. Post-training. One probe was conducted immediately after the mastery criterion for BS+MET was met to assess for generalization of the skill. This probe was conducted with the same procedures as the in situ probes and occurred at the participant’s worksite. All probes were novel to the participants and randomly selected. IST. IST was implemented if the participant scored a 2 or lower in response to the victimization statement during the post-training phase. These training sessions were conducted by the researcher and included the same procedures as in the in situ probes; however, upon completion of the probe, the participant was provided immediate feedback on their performance and asked to repeat a correct response if the participant scored less than a 4. IST was conducted until the participant responded with 100% accuracy in response to a novel victimization statement across 3 consecutive probes. Follow-up. Immediately after post-training or IST, the participant moved into the follow-up phase to control for the threat of maturation (Ledford & Gast, 2018). The follow-up phase consisted of in situ probes delivered by the researcher in the participant’s classroom or 17 worksite once per week or when another participant changed phases. Again, all probes in this phase were randomly selected novel victimization statements. Coworker probes. Coworker probes were conducted in situ at the participants’ internship worksites two weeks after completion of the BS+MET or IST training. Prior to the coworker probe, one coworker per participant was recruited and trained through BST to deliver the victimization statement during the coworker probe. Specifically, the coworker was taught to approach the participant, state the victimization statement, and to refrain from stepping away from where they were standing or sitting for 10 s after the participant responded. This was done to control for any instance in which data could be skewed due to the coworker moving towards the participant or both the participant and coworker moving at the same time from each other. Further, the coworkers were taught what to do in different scenarios, such as: what to do if the participant agrees to the request and does not walk or turn away; what to do if the participant does not agree to the request but does not walk away; what to do if the participant agrees to the request and walks away; and what to do if the participant does not agree to the request and walks away. Prior to conducting the coworker probe, the coworker was required to demonstrate 100% procedural fidelity in three consecutive role-plays with the researcher. As statements needed to be precisely delivered, the coworkers had access to statements on their cellular phones and were trained to make sure the participant could not see the phone screen during the probes. Procedural fidelity and interobserver agreement were assessed during coworker probes by the researcher. As in the in situ procedures, if the participant agreed to the request, the session was terminated through the coworker stating a predetermined phrase. If the participant displayed the 18 appropriate response to victimization, the coworker stated a phrase such as, “You’re right. I won’t ask again” and changed the subject of conversation or walked away from the participant. After the coworker assessment was complete, the primary researcher debriefed the participant and explained the victimization was not real and that she had asked the coworker to help her see if they would respond to the victimization if another person tried to victimize them. Generalization. Response generalization across exemplars was assessed throughout the study by scoring the participants’ response accuracy to the presentation of novel victimization statements during the in situ probes delivered during baseline, BS+MET, post- training, IST, and follow-up phases of the intervention (Ranick et al., 2013). Further, as none of the victimization statements presented in training were the same as those in the follow-up and coworker probes, each of the prior is representative of generalization to untrained stimuli. Response generalization was also assessed across settings throughout the study by scoring the participant’s accuracy to in situ probes in the classroom and their workplace. Finally, the coworker probe was conducted to assess if the response generalized from the researcher in the workplace to the participant’s coworker. Procedural Fidelity Procedural fidelity was assessed through every phase of the study to evaluate the extent to which all experimental phases were implemented with accuracy (Ledford & Gast, 2018), using a yes or no checklist that listed each step to be conducted in each phase. Procedural fidelity was assessed by a trained coder who either watched the video recording of BS+MET, IST, or the in situ probe or watched the in situ probe or IST live and completed the checklist by marking whether each step occurred or did not occur. Procedural fidelity was assessed for 50% of BS+MET sessions. Procedural fidelity was assessed for 37.5% of baseline probes (12 of 32), 19 55% of probes conducted during the BS+MET and post-training phases (5 of 9), 40% of probes conducted during the IST phase (4 of 10), 42.9% of follow-up probes (6 of 14), and 100% of coworker probes (3 of 3). In accordance with Ledford & Gast (2018), procedural fidelity was calculated as the number of checklist items scored as yes divided by the sum of the total items on the checklist multiplied by 100 to yield a percentage. Procedural fidelity for the BS+MET sessions and for the researcher conducted in situ probes throughout all phases of the study was 100%. Procedural fidelity for the coworker probes was 92.7% (ranging 89% to 100% for all 3 coworker probes). Data Analysis Data were analyzed using the visual analysis outlined by Kratochwill et al. (2010) to assess for a functional relation between the steps of the response to victimization performed and BS+MET and IST. Performance during all phases were coded and data were graphed following each probe and BS+MET or IST session so that data could be analyzed on a continual basis. Changes in level and trend, as well as variability, immediacy of effect, consistency of the data patterns, and overlap were assessed within and across each phase. More so, experimental control was determined through replication of data across participants. 20 Results Figure 1 depicts the number of steps of the response to victimization each participant completed correctly across all phases of the study. The multiple probe experimental design used in the study allowed for a potential of four demonstrations of effect across the four participants. By using visual analysis, a total of four demonstrations of positive effect were indicated from baseline to follow-up. During baseline, two participants scored between 0 and 1 and two participants scored between 0 and 2 for all in situ probes; all participants’ data during baseline displayed no trend and varied between low to moderate levels. All participants increased accurate responding to victimization from baseline to BS+MET probes, as indicated by a change in level ranging from moderate to high and rapid immediacy of effects seen for three participants (all except Ella). All participants met mastery criterion during role-play after three to five BS+MET sessions. Two participants received a score of 2 on the in situ probe following BS+MET, therefore requiring additional IST. Follow-up in situ probes were conducted for three of the four participants following either BS+MET or IST. All three participants maintained the skill during the follow-up in situ probes, as indicated by data that ranged from moderate to high levels throughout follow-up. Finally, a coworker probe was conducted with three of the four participants 2 weeks following BS+MET or IST; participants performed between 2 and 4 steps correctly during these probes. Ben During baseline in situ probes, Ben scored between 0 and 1, displaying low levels of accurate responding; although he abstained from retaliation on all five probes, he agreed to the request during one probe (leading to a score of 0 for that probe). Ben met mastery criterion during role-play within four sessions of BS+MET. He received one in situ probe during 21 BS+MET and scored a 3, showing a rapid immediacy of effect and increase in level. After meeting mastery criterion in BS+MET, Ben scored a 2 on the post-training probe, with the data displaying a decrease in level and a decreasing trend. As such, Ben received IST and responded with 100% accuracy during each IST probe, meeting mastery criterion after three consecutive probes and displaying an increase in level and change of trend. Following IST, Ben scored a 4 on the in situ probe, but his performance was variable as indicated by a 2 on the coworker probe (i.e., he abstained from retaliation and declined the request). Ben then scored 4 on six consecutive follow up in situ probes before scoring 3 on the final probe, maintaining the high level of accurate responding. Kyle During baseline in situ probes, Kyle scored between 0 and 1, displaying low levels of accurate responding; although he abstained from retaliation on all eight probes, he agreed to the request during three probes. Kyle met mastery criterion during role-play within four sessions of BS+MET. He received one in situ probe during BS+MET and scored a 4, showing a rapid immediate effect and increase in level. After meeting mastery criterion in BS+MET, Kyle scored a 2 on the post-training probe, with the data displaying a decrease in level and a decreasing trend. As such, Kyle received IST and met mastery criterion after seven probes. During the first and fourth IST sessions, Kyle scored a 2 for probes that were theft related, displaying no increase in level nor trend; for the other IST probes, Kyle scored a 4, showing an increase in level and upward trend. Following IST, Kyle was expelled from the school-to-work transition program and his participation was terminated. 22 Ella During baseline in situ probes, Ella scored between 0 and 2, displaying low to moderate levels of accurate responding; although she abstained from retaliation on all nine probes, she agreed to the request during three probes. Ella met mastery criterion during role-play within five sessions of BS+MET. She received two in situ probes during BS+MET and scored a 2 and a 4, showing an upward trend and increase in level. After meeting mastery criterion in BS+MET, Ella scored a 4 on the post-training probe, indicating a high level of accuracy. As such, Ella progressed to follow-up, where she scored a 4 on the in situ probe and a 3 on the coworker probe (i.e., she abstained from retaliation, declined the request, and walked or turned away). Ella then scored 4 on two consecutive follow-up assessments, maintaining high a level of accuracy. Zev During baseline in situ probes, Zev scored between 0 and 2, displaying low to moderate levels of accurate responding; although he abstained from retaliation on all 10 probes, he agreed to the request during three probes. Zev met mastery criterion during role-play within three sessions of BS+MET. He received one in situ probe during BS+MET and scored a 4, showing an immediate effect and increase in level. After meeting mastery criterion in BS+MET, Zev scored a 4 on the post-training probe. As such, Zev progressed to follow-up, where he scored a 4 on the in situ probe and a 4 on the coworker probe. Zev then scored 4 on two consecutive follow-up in situ probes, maintaining the high level of accuracy displayed after BS+MET. 23 Discussion This study evaluated the effectiveness of BS+MET to teach young adults with IDD to recognize and respond to workplace victimization. Four participants were taught a four-step response to coworker victimization including abstaining from retaliation, declining the request, acknowledging victimization, and walking or turning away. All four participants increased correct responding from baseline to the completion of the training and displayed generalization to the workplace and to a coworker follow-up, thus indicating a functional relation exists between BS+MET or BS+MET and IST and the performance of the steps of the response to victimization. Experimental control was also indicated through the replication of data and the demonstration of effects across participants. Results of the survey conducted prior to the intervention ensured the types of victimization taught in the intervention were socially valid. The intervention was relatively inexpensive and required few materials (paper visual aids and a PowerPoint presentation), indicating this is an effective and efficient intervention for other school-to-work transition programs to replicate in the future. This study extended research on BST, MET, and IST to teach victimization prevention skills to individuals with IDD. All four participants met mastery criterion for BS+MET within five sessions, indicating that BS+MET was an efficient and effective method to teach young adults with IDD to recognize and respond to coworker victimization during role-play scenarios. Despite this, on the post-training probe two participants, Ben and Kyle, did not complete all four steps of the response to victimization and required additional IST to acquire and generalize the skill. These results are similar to other studies that have utilized BST as a teaching strategy for adults with IDD (Sanchez & Miltenberger, 2015; Stannis et al., 2019) in that all participants quickly acquired and displayed the response to victimization skills during BST role-play but only 24 half of the participants generalized the skill during the post-training in situ assessments. The present study’s data suggest that a treatment package of BS+MET may be effective in teaching some individuals with IDD a response to victimization, but others may need additional IST to acquire the steps of the response. More broadly, this study’s data suggests that the incorporation of MET into BST may reduce the need for IST to maintain and generalize accurate responding of safety skills. A limitation frequently seen throughout the BST literature is that skills do not generalize to the natural environment following BST, requiring additional in situ training (Miltenberger, 2008). To mitigate this limitation, the current study planned for generalization by incorporating MET into the BST. For two participants in the current study, Ella and Zev, additional IST was not necessary which is not consistent with previous BST literature. As such, the addition of MET to the BST might have improved generalization of the response, eliminating the need for additional IST. If this is the case, incorporating MET into BST in future research and applied practice could significantly reduce the need for prolonged and intensive training associated with IST for some, while others may still require additional IST. Following BS+MET and IST, the response generalized for the three participants who received in situ probes in the workplace conducted by both the primary researcher and a coworker. During follow-up, 5 of 9 probes for Ben, 3 of 4 probes for Ella, and 3 of 4 probes for Zev were conducted at their workplace. Although all three participants scored 4 on the probes conducted by the researcher, two participants scored lower on the probes conducted by a coworker. As such, compared to baseline data, the response to victimization generalized across settings from the classroom to the workplace. Further, despite scores ranging from 2 to 4 on the coworker probes, all three participants displayed the most important skill to prevent 25 victimization, in that no participant agreed to the request or retaliated during the coworker probes. These results indicate that although the full response to victimization did not generalize to the coworker probe for two of the participants, they were able generalize the essential steps necessary to prevent themselves from being victimized or fired. In programming for generalization, the response to victimization was taught loosely during BST. That is, the participants were taught various responses based on the specific victimization statement rather than a scripted, generic response. For instance, if the victimization statement was “I lost my credit card. Can I use yours to buy my lunch?” the researcher modeled a correct response of abstaining from retaliation, saying “no, that would be stealing my money,” and walking or turning away. Ben, Kyle, and Zev all met mastery criterion through this loose teaching method. Ella, however, was unable to display a response that met mastery criterion using this method. As such, on the second training session, the decision was made to teach Ella a scripted response of abstaining from retaliation, saying “no, that’s wrong,” and walking or turning away. Using this scripted response, Ella met mastery criterion for BS+MET, did not require IST, displayed generalization of the skill during the coworker probe, and maintained accurate performance of the response during the follow-up probes. As a part of MET, each participant was taught to recognize and respond to three types of coworker victimization at three different difficulties during BS+MET and IST. Although the purpose of this study was not to evaluate differences in responding based on the type of victimization or level of difficulty, observed patterns in the data may indicate that the type of victimization stated during the in situ probe may have impacted response accuracy for certain participants. For instance, during baseline Ella agreed to the request for all probes related to assuming the person with IDD is not able to do a work task because of their disability, but she 26 did not agree to requests related to theft or to calling her a pet name/infantilization. More so, the three probes in which Kyle did not respond appropriately with all 4 steps after BS+MET were related to theft. Given these differences in performance on different types of victimization, future research should more systematically examine whether individuals with IDD have more or less difficulty responding to certain types of victimization. Alternatively, the difficulty of the victimization statement to be detected as victimization may also have affected response accuracy for the participants. Specifically, it is likely that the harder or more subtle probes may have been more difficult for the participants to recognize. Although BS+MET training began with easier to recognize examples of victimization and progressed to teaching recognition and responding to harder to recognize examples of victimization, it is possible that the participants had more difficulty with the harder to recognize victimization statements during in situ assessments. For instance, during the post-training and coworker probes for Ben (Ben scored a 2 for both these probes), he was presented with in situ probes categorized as “hard.” It is a possibility, based on his previous accurate responding prior to these probes, that if the probes were easier to recognize, his response accuracy would have increased. Again, differing difficulty of victimization statements in this study was incorporated for BS+MET purposes to enhance generalization. As such, differing difficulty was not included to systematically examine the accuracy of response related to difficulty of victimization statements. Future research should systematically examine whether the level of difficulty is related to responding. Limitations and Future Research Despite the positive results, there are limitations to be considered. First, the operational definition of the steps of the response to victimization, particularly the definition for walking or 27 turning away, was sometimes too limited. For example, the participant was required to walk three steps away or turn their body more than 90 degrees to be considered a correct response. If the participant said goodbye, moved onto their next work task, or started helping the next customer in line (all behaviors that typically indicate the end of a conversation), their response was not counted as correct. During Ben’s final follow-up probe conducted at his workplace (a cafeteria), the researcher approached Ben while she was in line to be served and stated the victimization statement. Ben responded by abstaining from retaliation, saying no, acknowledging the victimization, and then asking the next customer what they would like. Because Ben did not walk more than three steps away nor turn his body more than 90 degrees, this response was scored as a 3, despite clearly indicating the end of the conversation with the researcher in an appropriate manner. A more comprehensive and functional definition should be used in future research that includes any vocal verbal statement or physical movement indicating the end of the conversation with the perpetrator of victimization. Another limitation of the study was that the researcher may have possibly become a discriminative stimulus for the in situ probes, leading to unintended stimulus control. For example, two of the three participants responded with lesser accuracy during coworker probes than during the other follow-up in situ probes conducted by the researcher. This stimulus control could be addressed in future research by having multiple people deliver in situ probes throughout training or through conducting a coworker probe in baseline to assess for this stimulus control. Future research should also evaluate this intervention package to teach a response to victimization from/including others pertinent in a working adult with IDD’s life, including peers, supervisors, and other vocational staff (such as job coaches). 28 Finally, several difficulties were encountered throughout the course of the study. First, Kyle was removed from the school-to-work transition program due to an incident that occurred outside of the training for this study. His removal from the program was outside of the researchers’ control and thus data collection for this participant was terminated. Given his performance prior to his removal from the study, it was anticipated that Kyle would have continued to perform accurately to in situ probes across settings and with the coworker, although he may have performed with lesser accuracy to probes related to theft as low accuracy was displayed for three probes during BS+MET and IST for this type of victimization. Also, due to the shutdown of all public schools and businesses to combat the spread of COVID-19, long-term maintenance probes were not able to be collected. Maintenance of the skill can be assumed through the accuracy of response to follow-up in situ probes (conducted one time per week). Ben maintained accuracy of the response to victimization for nine weeks post training, Ella for four weeks post training, and Zev for four weeks post training. Conclusion Individuals with IDD are at an increased risk of workplace victimization compared to their neurotypical peers. Although teaching workers with IDD a response to victimization protocol is one way to help prevent being taken advantage of, little research has been conducted on teaching this prevention skill. The current study offers evidence that a training protocol of BST combined with MET and additional IST for some participants may be effective in teaching a response to workplace victimization scenarios and decreasing the experience of coworker victimization. The BS+MET response to victimization protocol used in the current study has implications for workers with IDD in general. It is essential for workers with IDD to know the 29 risks they face at work that could lead to them being taken advantage of by a coworker. This protocol, or ones similarly developed based on the needs of the workers, could be used by teachers, rehabilitation counselors, job developers, job coaches, or even job supervisors to teach workers with IDD how to protect themselves, their possessions, and their job status. More so, further examination of workplace victimization prevention protocols could improve the safety, skills, and confidence of individuals with IDD to work in competitive, integrative settings so that they may live more independent lives. 30 APPENDIX 31 Table 1: Scoring Guide for In Situ Probes Score Steps Completed Correctly 0 1 2 Participant retaliates or agrees to the request Participant abstains from retaliation Participant abstains from retaliation + 1 of the following: decline the request, responds by acknowledging victimization, or walks/turns away 3 Participant abstains from retaliation + 2 of the following: declines the request, responds by acknowledging victimization, or walks/turns away 4 Participant abstains from retaliation + all of the following: declines the request, responds by acknowledging victimization, and walks/turns away 32 Table 2: Timeline and Information for Each Phase of Study Baseline BS+MET Post- Training IST Follow-Up Coworker Procedure In situ probes BS+MET In situ probe In situ probes In situ probes with immediate feedback Location Classroom and worksite Classroom and worksite Worksite Classroom and worksite Criterion responding Independent performance for 4 of 5 role-plays, 3 consecutive days (80%) 100% accuracy for 3 consecutive probes Probe In situ probes In situ probes Classroom Worksite and Worksite When Prior to BS+MET Immediately after baseline Immediately Immediately Immediately 2 weeks after BS+MET after BS+MET if post-training was less than or equal to 2 after post- training or IST post training How often conducted Every 1-2 Every 1-2 Once Every 1-2 Every 4-5 Once, 2 days days weeks after BS+MET concluded days or when another participant changed phases days for first participant. 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