an evaluation of computerized behavioral skills training to teach safety skills to young children

AN EVALUATION OF COMPUTERIZED BEHAVIORAL SKILLSTRAINING TO TEACH SAFETY SKILLS TO YOUNG CHILDREN

NICHOLAS R. VANSELOW AND GREGORY P. HANLEY

WESTERN NEW ENGLAND UNIVERSITY

Previous research has demonstrated the efficacy of behavioral skills training (BST) and in situtraining (IST) for teaching children to protect themselves. However, BSTmay be resource intensiveand difficult to implement on a large scale. We evaluated a computerized version of BST (CBST) toteach safety skills and determined the extent to which safety skills generalized across differentdangers. In Study 1, 11 children learned, via CBSTand IST, to respond safely when asked to leavewith a stranger. In Studies 2 and 3, ISTwas implemented with 16 children for 1 or 2 dangers afterexposure to CBST for 3 dangers. Participants correctly self-protected from dangers after CBSTandIST, and performance generalized to similar dangers for which participants did not receive IST.CBSTmay be an acceptable substitute for BSTwhen combined with IST to improve efficiency andmaintain efficacy in a comprehensive safety skills program.Key words: behavioral skills training, computer-based teaching, dangers, in situ training,

lighters, poison, safety skills, stranger

Unintentional drowning, burns, firearm play,poisoning, and suffocation are among the top 10leading causes of injury-related deaths for 5- to9-year-old children (Centers for Disease Controland Prevention, 2011). There are two possiblecourses of action to prevent unnecessary injuriesand deaths. The first is environmental modifica-tion such as childproof locks and increasedsupervision. Although environmental modifica-tions are necessary and are often successful,modifications may sometimes fail. The secondpossibility is to teach children to protectthemselves.

Previous research has demonstrated thatchildren do not protect themselves reliably indangerous situations. In two studies (Beck& Miltenberger, 2009; Poche, Yoder, &

Miltenberger, 1988), 25 of 26 children (5 to8 years old) did not get away from or tell an adultabout a stranger who approached them. In twoother studies (Kelso, Miltenberger, Waters,Egemo-Helm, & Bagne, 2007; Miltenbergeret al., 2009), 7 of 52 children (6 to 9 years old)touched a gun, and 37 children did not get awayor tell an adult about the gun. Childrencontinued to respond incorrectly to dangeroussituations even after they received traditionalinstruction that consisted of videos and lectures.In Poche et al. (1988), 24 of 35 children stayednear a stranger after listening to a standardlecture-type presentation about strangers orwatching a videotape, and in Beck and Milten-berger (2009), five of six children continued tostay near strangers after watching a video. InHimle, Miltenberger, Gatheridge, and Flessner(2004), a treatment group composed of 11children did not have a higher average safety scorethan a control group composed of 10 childrenduring an in situ assessment after they watched acommercially available gun safety video.

Previous studies have demonstrated the effica-cy of behavioral skills training (BST) for teachingsafety skills to young children (Johnson et al.,2005, 2006; Poche, Brouwer, & Swearingen,

An earlier version of this article was submitted by the firstauthor as a dissertation to Western New England Universityin partial fulfillment of requirements for a doctoral degree.The computer game described in this series of experiments isnot currently available publicly, but, after further testing, willlikely be released in the future.

Correspondence concerning this article should beaddressed to Nicholas Vanselow, who is now at Salve ReginaUniversity, Psychology Department, 100 Ochre Point Ave.,Newport, Rhode Island 02840 (e-mail: [email protected]).

doi: 10.1002/jaba.105

JOURNAL OF APPLIED BEHAVIOR ANALYSIS 2014, 47, 51–69 NUMBER 1 (SPRING)

51

1981; Poche et al., 1988). During BST, a teacherfirst provides instructions about the danger andhow to respond to the danger. The teacher thenreenacts a scenario with the danger and modelsthe correct response. Finally, the teacher arrangesa simulation, and the students respond to thedanger in a role-play. During the role-play, theteacher provides feedback that may include praisefor correct responses and vocal, model, orphysical prompts after incorrect responses. BSTis different from traditional “stranger danger”programs primarily because children act outdangerous situations and receive feedback ontheir performance.Limitations of BST are revealed during in situ

assessments that involve reproducing the dangerin the natural setting without the child knowing aparent or teacher is watching. Himle, Milten-berger, Gatheridge, and Flessner (2004) foundthat most children did not leave an area with agun or report the danger to an adult after theyreceived BST. In a study that evaluated poisonsafety conducted by Dancho, Thompson, andRhoades (2008), children continued to consumeitems from ambiguous containers after two30-min training sessions that included BST. Ina relatively large study with 46 children (6 and7 years old), 30% did not get away from anabductor or tell an adult during an in situassessment that occurred after BST (Johnsonet al., 2006). An additional 14% moved awayfrom the stranger but did not report the situationto an adult.BST is one of the most effective interventions

currently available, but not all children respondcorrectly to dangers after only experiencing BST.In many cases, children may also require in situtraining (IST) to protect themselves fromdangerous situations. During IST, a parent orteacher arranges for the danger to appear in amore natural setting (e.g., a confederate strangerapproaches a child at the playground), and theparent or teacher arrives to provide feedback afterthe child responds to the danger. Previous studieshave shown consistent improvement for partic-

ipants during in situ assessments following BST,only after ISTwas added (Beck & Miltenberger,2009; Dancho et al., 2008; Himle, Miltenberger,Flessner, & Gatheridge, 2004; Jostad, Milten-berger, Kelso, & Knudson, 2008; Miltenbergeret al., 2009).Although the combination of BST and IST is

effective, Jostad and Miltenberger (2004) suggestthat BSTand IST, when presented individually toeach child as typically described, may be difficultto implement on a large scale (e.g., to all childrenin a classroom or school), and therefore modi-fications to the procedures that increase efficiencyshould be evaluated. In one of the most efficientdemonstrations of BST, Carroll-Rowan andMiltenberger (1994) reported that BST wasconducted on 3 separate days and lastedapproximately 20min for a classroom of 23students for a total of 60min of training time.Due to the individual rehearsal required duringBST, as the number of children taught increases,so does the duration of training time. For theaverage primary school of 446 students (NationalCenter for Education Statistics, 2001), trainingwould consume 20 hr of instructional time foronly the BST component and for only onedanger. The estimate does not include the timerequired to train those who implement BST to doso correctly. School administrators and teachersare thus likely to seek programs that reduce thetime required to teach safety skills. To that end,knowledge assessments (i.e., measures of vocalresponses to questions) are sometimes substitutedfor measurement of behavior during an in situassessment. Many studies suggest, however,that performance during knowledge assessmentsdoes not predict performance during role-playsor in situ assessments. For example, Himle,Miltenberger, Gatheridge, and Flessner (2004)reported that five children could tell an experi-menter how to respond to gun safety scenariosafter they had viewed commercially availablegun safety videos, but none of the five respondedcorrectly during an in situ assessment. Carroll-Rowan and Miltenberger (1994) found that

52 NICHOLAS R. VANSELOW and GREGORY P. HANLEY

approximately 30% of participants performedbetter in knowledge assessments than during insitu assessments after they had received varioustypes of training for abduction-prevention skills.Replacing in situ assessments with knowledgeassessments may save time; however, the cost is anincreased chance that the correct safety skills willnot be used when a child encounters an actualthreat.Some researchers have attempted to package

BST into videos and manuals for easier imple-mentation in schools. Carroll-Rowan andMiltenberger (1994) found that teachers imple-mented BST correctly while following a manual,and that the efficacy of the video and the manualwere similar. Nevertheless, most children re-quired IST.Other ways to save time and resourcesare to present BST to groups of children orinclude children as trainers. Based on their reviewof self-protection studies that used individual andgroup training, Miltenberger and Olsen (1996)asserted that fewer children learned all of thesafety skills in the studies using group trainingcompared to those that used individual training.Jostad et al. (2008) trained 6- and 7-year-oldchildren to provide BST for gun safety as peertutors to 4- and 5-year-old children. The use ofpeers may decrease the staff resources required fortraining, but resources are still required to providetraining for the peers. Given these challenges, it isnot surprising that school administrators andteachers use coloring books, videos, and lecturesto teach safety skills, even though these tools areroutinely ineffective (Carroll, Miltenberger, &O’Neill, 1992).Previous research has demonstrated the gener-

ality of acquired safety skills across differentexemplars of the same danger (e.g., differentpoison containers or different lures used by anabductor; Dancho et al., 2008; Poche et al.,1981) and across settings (e.g., Poche et al.,1981). Previous self-protection research has not,however, evaluated generalization of safety skillsacross distinctly different dangers. Children mayencounter more than one type of danger and need

to know how to respond appropriately to eachone. Appropriate responses to different dangersare similar in many ways: Identify that a danger ispresent, move away from the danger, and reportthe danger to an adult. However, research has notevaluated procedures for promoting generaliza-tion across dangers, and it is unknown whetherteaching safety skills for one danger will general-ize to others.The purpose of the current series of studies was

to evaluate the effects of a computerized versionof BST (CBST) on the acquisition, maintenance,and generalization of safety skills with respect tomultiple dangers. A computer game withinteractive components was investigated becauseprevious research has demonstrated that video-only treatments may be ineffective (Beck &Miltenberger, 2009). A computer game, ifeffective, would be a relatively easy way toprovide instruction, modeling, and individual-ized feedback to young children and would havesome advantages over BST for school-wideimplementation. First, no training of teacherswould be required for BST. Teachers would onlyneed access to computers with the computergame to deliver the program effectively. Second,computerized training can present many differentsituations easily via video. During classroom role-plays, children experience a dangerous situationwith only a single adult or a particular gun,poison, lighter, and so on. In a computer game,children can view and role-play a variety ofdangers and situations presented via video. Third,a computer program allows multiple children tobe taught self-protection skills while maintainingthe benefits of individualized instruction andproviding each child with immediate and indivi-dualized feedback for performance throughoutthe program.

STUDY 1: ABDUCTION PREVENTION

The purpose of Study 1 was to evaluate theefficacy of CBST for teaching children to respondsafely to a single danger.

COMPUTERIZED BEHAVIORAL SKILLS TRAINING 53

Participants and SettingsThe authors contacted a local preschool, which

primarily served families of low socioeconomicstatus and which had indicated an interest inteaching safety skills to their students. Consentforms were sent home to the parents of childrenin a classroom of typically developing 5- and6-year-olds. Children whose parents consentedwere selected to participate based on teacherreports of consistent attendance. Twelve childrenbegan participation in Study 1. One participantrefused to participate in the in situ assessments;therefore, 11 children completed the training andanalysis. All in situ assessments, as well as IST,were conducted in a hallway in the school. Thecomputer program was presented in a small roomat the school.

DesignWe evaluated the efficacy of the CBST for

improving self-protection skills in a concurrentmultiple baseline design across subjects. Weconducted in situ assessments for each participantbefore and after the participant completed CBST.An IST phase was conducted if a participant didnot protect him- or herself following CBSTalone.CBSTwas conducted once before all of the post-CBST in situ assessments and was repeated beforethe first IST session was conducted. During theIST phase, the experimenter implemented ISTwhenever the participant made an error during anin situ assessment. Participants were randomly

assigned to a short, medium, or long baseline.The actual length of the baseline for each groupwas determined by visual inspection of the data.

Data Collection and Interobserver AgreementDuring in situ assessments, observers scored

whether participants interacted with the stranger,got away from the stranger and moved toward asafe adult (e.g., the experimenter or classroomteacher), and reported the stranger to an adult.Table 1 summarizes the possible participantresponses. Reports of dangers were scored if theparticipant made a statement to the safe adultindicating that there was a danger or that he orshe had spoken to a stranger. Any response thatspecifically indicated a stranger or a response thatwould cause an adult to become concerned andpossibly ask follow-up questions was counted asa report. Participants had an opportunity to tellan adult without getting away from the strangerbecause the experimenter returned to the parti-cipant at the end of each assessment.The experimenter and the confederate stranger

independently recorded participant responsesduring the in situ assessment. Sessions werevideotaped using a very small camera hiddeninside the experimenter’s wristwatch. Thestranger recorded audio for the session with ahandheld voice recorder. Data collectors used thevideo and audio recordings if the experimenterand stranger could not see part of a participant’sresponse.

Table 1Summary of Child Responses During In Situ Assessments

Category Definition

Get away and tell The participant began moving away from the danger within 5 s (strangers) or 10 s (lighters andpoisons) to a distance arm’s length from the experimenter; then reported the danger to theexperimenter.

Get away The participant moved away from the danger within 5 s to within arm’s length of the experimenter, butdid not report the danger.

Tell an adult The participant remained near the danger, but reported the danger when the experimenter returned.Stay near danger The participant remained near the danger for more than 5 s (strangers) or 10 s (lighters and poisons)

and did not report the danger.Interact with danger The participant interacted with the danger at any time during the in situ assessment regardless of

reporting or getting away.


Interobserver agreement data between theexperimenter and the confederate stranger werecollected on an average of 35% of in situassessment sessions (range across phases andparticipants, 25% to 57%). Interobserver agree-ment was assessed for four responses: interactingwith the danger, staying near the danger, gettingaway, and telling an adult. In each trial, anagreement was scored for each of the fourresponses if both observers recorded an occur-rence or a nonoccurrence. Otherwise, a disagree-ment was scored. Agreement was calculated as apercentage of agreement for each session andaveraged 97% across all sessions and participants(range, 75% to 100%).

ProcedureIn situ assessment. Before the first in situ

assessment, the participant’s classroom teacherintroduced the experimenter. At the beginning ofeach assessment, the experimenter came to theclassroom and told the participant that they weregoing to play a game in a different room in theschool. The participant was allowed to choose agame or toy to play with for 10min when theexperimenter and participant reached the smallroom. Either on the way to the small room or onthe way back to the classroom, the experimenterpretended to forget something or need to take aphone call. He moved at least 1.5m away fromthe participant and around the corner of anotherhallway. In some sessions, no stranger approachedthe participant; the experimenter simply returnedand continued to the destination with him or her.Whether the experimenter received a phone call,forgot something, or nothing happened, andwhether or not a stranger appeared, was deter-mined randomly before each session, with therestriction that one of every three sessions did nothave a stranger.If a stranger was scheduled for a session, he or

she approached the participant shortly after theexperimenter left. Strangers were undergraduatestudents in their early twenties. Participantsencountered some strangers in baseline and again

in some sessions after CBST; however, otherstrangers appeared only in baseline or only afterCBST. After approaching the participant, theconfederate stranger made a comment aboutsomething the participant was wearing or hadwith him or her. The stranger then asked theparticipant to leave the area with him or her (e.g.,“Wow! That is a cool shirt. Let’s play over here.”)and extended his or her hand to the participant.The stranger walked with the participant awayfrom the experimenter if the participant agreed togo with him or her. The experimenter casuallyinterrupted the participant and stranger if theywalked more than 3m away from him. If thisoccurred, the stranger walked away, and theexperimenter and participant continued to theiroriginal destination. The stranger asked theparticipant to leave a second time if theparticipant did not move more than 1m awayin 5 s. The stranger walked away and theexperimenter returned if the participant did notmove away within 5 s after the second request toleave. If the participant told the experimenterabout the stranger after the experimenterreturned, the experimenter said, “Thank youfor telling me,” in a calm neutral tone. If theparticipant moved away from the stranger but didnot report the stranger, the experimenter did notprovide praise. If the participant moved awayfrom the stranger and within arm’s reach of theexperimenter within 5 s and reported thestranger, the experimenter praised him or her(e.g., “Thank you for telling me. You did a greatjob getting away from that stranger and telling meabout it.”). After the assessment, the participantand the experimenter continued on to theoriginal destination.Computerized behavioral skills training (CBST).

The first author created a computer programusing the Adobe Production Premium SoftwareSuite and the ActionScript 3 programminglanguage. The program was presented using aWindows-based laptop computer with a standardmouse. Participants played the computer game ina single session that lasted approximately 20min.


Before starting CBST, the experimenter toldthe participant that they would be playing a gamethat would teach them to stay safe. Outside theroom was a life-sized cardboard cutout of thecharacter who narrated the computer game. Theparticipant was introduced to the cardboardcharacter and the experimenter pointed out apouch attached to the cutout. The experimenterexplained that the participant would be talking tothe cardboard cutout later during the program.Participants appeared to enjoy the cardboardcutout and often gave it hugs or high fives. Afterthe participant sat in front of the computer, theexperimenter placed 10 tokens on the tablenearby. The experimenter told the participantthat the tokens would be used later. He thenhelped the participant to type his or her name inthe welcome screen on the computer and startedthe computer program.A few components were present throughout

the entire computer program. First, a screen witha pool and an animated stick figure indicated theparticipant’s progress through the entire program(see Figure 1, left). The pool filled up a smallamount after the participant completed eachmodule. A “Dive” button appeared when the

pool was full and the participant had completedall of the modules. Clicking the “Dive” buttoncaused the animated stick figure to dive into thepool with a splash. The stick figure reemergedfrom the water and waved goodbye before theprogram closed. Second, a paper airplane at thetop of the screen indicated progress through eachindividual module when the participant wasrequired to respond. Figure 1 (right) shows thepaper plane at the top of the screen. The planemoved across the screen when a participant madea correct response. The plane stopped in the goalarea, and the module ended when the participantmade the total number of correct responsesrequired. Third, a live-action on-screen narrator(the same person as the cardboard cutout)delivered instructions and provided praise andcorrective feedback throughout the program.Although some textual stimuli were presentedthroughout the program, the text was supple-mented by pictures and vocal instruction fromthe narrator, and did not require a readingrepertoire. Table 2 provides a summary of theindividual modules included in the game.The first module introduced participants to

the program and provided instruction on how to

Figure 1. Screen shots of the computer program. The right panel shows the pool screen that tracked participant progressthrough the game. The left panel shows a module from the version of the game that was used in Studies 2 and 3, in whichparticipants moved the pictures of safe and unsafe items to the two boxes at the bottom of the screen. The paper plane at thetop of the screen keeps track of points and progress through the module.


use the mouse to interact with future modules.The remaining modules consisted of componentssimilar to other BST packages (e.g., Beck &Miltenberger, 2009).Instructions and modeling. In this module, an

on-screen narrator first provided instructionsabout strangers, including who is a stranger andhow to respond. Next, the participants watchedvideos of similarly aged children respondingcorrectly to a stranger. In one case, a child inthe video went with a stranger and a parentapproached the child, provided amild reprimand,and reminded the child of the correct steps. Theincorrect model was included to show childrenthe contingencies for behaving appropriately andinappropriately with respect to strangers. Stu-dents practiced skills related to the informationfrom the instructions and modeling portion ofthe program in the other subgames of the CBSTprogram.Order game. Before this game began, the

participant was given the opportunity to changethe color of the mouse cursor on the screen. Theability to change the cursor color was added toprovide the participant with some choices during

the game and was not relevant to the skill beingtaught. During the game, there were three videoclips on the left side of the screen. The participantwas required to move the videos into the correctorder (say “no,” get away, and tell an adult) tomove on. If the participant attempted to movethe video to the incorrect position, the videomoved back to its original position. The videosnapped into place on the right side of the screen,and a green checkmark appeared over the video ifthe participant moved the video to the correctlocation. A large blue arrow pointed to the correctlocation for the video if the participant moved avideo to the incorrect location twice during atrial. The participant was required to move all thevideos into the correct order, with fewer thanthree errors in six trials, to move to the nextmodule. Correct trials did not have to beconsecutive.Go! game. Participants from pilot studies had

difficulty with getting away from strangers duringin situ assessments. The Go! game was added toemphasize getting away from a stranger as a keystep for self-protection. Before the game began,the participant was allowed to choose the color of

Table 2Summary of CBST Components

Components Description Study 1 Studies 2 and 3

Instructions and modeling The narrator verbally described dangers and appropriate safetyresponses and included video models of children responding todangers.

X X

Order Participants were taught to put the three safety steps (“no,” go, and tell)depicted in short video clips in order.

X X

Go! The game stressed the importance of getting away from dangers.Danger appeared on the screen and participants were required toclick “go!” within 5 s.

X X

Danger sorting The participant was taught to discriminate safe and unsafe objects. Theparticipant was required to move pictures of safe and unsafe objectsinto boxes or tell a stick figure to get away or stay near and objectusing buttons on the screen.

X

Act Out game Danger appeared on the screen, and participants were asked to getaway from the computer and tell the cardboard cutout about thedanger.

X X

ActþRun! game Identical to the Act Out game, except the on-screen narrator appearedshortly after the danger and encouraged the participant to get awayquickly.

X

Note. Included dangers were strangers in Study 1 and strangers, lighters, and poisons in Studies 2 and 3.


the stick figure for the game. During the game,there was a large button with the word “go!” and apicture of a stick figure running. Above thebutton was the stick figure chosen by theparticipant. A video of a stranger asking theparticipant to leave appeared to the left of thestick figure. A correct response required theparticipant to click the “go!” button within 3 s ofthe stranger’s appearance on the screen. A correctresponse caused the stick figure to run away fromthe video of the stranger. The on-screen narratorprovided praise or said, “Too slow; get awayfaster,” if latency to clicking the “go!” buttonexceeded 3 s. The narrator said, “That was toofast. Wait for the stranger to ask you to go,” if theparticipant clicked the “go!” button before thestranger appeared. The participant was requiredto click the “go!” button within 3 s on six trials tomove to the next module.Act Out game. This game was designed to be

similar to rehearsal during BST. Participants weregiven the opportunity to respond physically to asimulated stranger and to receive individualizedfeedback on their performance. Before beginningthe computer program, participants were given10 round laminated paper tokens with a pictureof a stick figure running on one side and a stickfigure saying “stranger!” on the back. During thegame, the participants were instructed to givethese tokens to the cardboard cutout of the on-screen narrator. Pilot testing of this gameindicated that children were confused by theinstruction to get away from the stranger on thecomputer screen until we added these tokens.Tokens were not contingent on any responses. Atthe beginning of the game, the participantswatched a video of the on-screen narrator play thegame four times. The first time, after saying “no,”the narrator walked to the cardboard cutout andput one of the tokens in an attached pouch beforesaying “I saw a stranger.” In the second video, thenarrator saw the stranger but did not act out thesafety skills. The narrator watched the errormessage and appeared to be frustrated. The thirdvideo was similar to the first but with fewer

instructions about each step. During the finalportion of the instructions for the Act Out game,the narrator told the participant to complete thesafety skills even if there were no tokens left. Thenarrator modeled the correct response without atoken.After the instructions, a stranger, who the

participant had not seen before, appeared in thecenter of the screen. Below the stranger video wasan “OK” button that remained on screen for theduration of the trial. Occasionally, before astranger appeared, the narrator appeared and saidsomething an adult might say before leaving achild alone, for example, “One second, I need tomake a phone call. I’ll be right back.” After thenarrator disappeared, the stranger appeared andasked the participant to leave. The computerprogram counted a response as correct if at least4 s elapsed between the stranger’s appearance andthe participant clicking the “OK” button to endthe trial. If the participant clicked the “OK”button before 4 s elapsed, the narrator appearedand instructed the participant to act out thecorrect response. Clicking the “OK” button 4 safter the stranger’s appearance resulted in praisefrom the narrator. To move to the next module,the participant was required to click the “OK”button 4 s after the stranger appeared on six trials.ActþRun! game. The ActþRun! game was

identical to the Act Out game, except that the on-screen narrator yelled “Run! Get away from thestranger!” or similar phrases when a strangerappeared. The additional prompt was added tosignal the importance of getting away quickly. Sixcorrect responses were required to complete thisgame. The participant did not have any remain-ing tokens for the last two trials if he or she hadresponded correctly during the Act Out game.This part of the program gave participants anopportunity to emit the correct safety responsewithout giving a token to the cardboard cutout ifhe or she did not have any tokens left.In situ training (IST). IST was implemented

during in situ assessments that occurred after thelast post-CBSTsession if a participant did not get


away from the stranger and tell an adult. Theparticipant replayed the computer game betweenthe last post-CBST session and the first ISTsession. During IST, the experimenter ap-proached the participant and described themistake made: “When a stranger asks you toleave, make sure you get away. Let’s practice.”After the instructions, the experimenter left theparticipant, and the stranger again approachedthe participant. The experimenter used least-to-most prompting (gestures and short vocalinstructions) to ensure that the participantmade the correct response. Training was repeatedeach session until the participant correctly gotaway from the stranger and reported the strangerto the experimenter without any prompts.Typically, one or two trials of IST occurred persession.Additional consequences. IST was ineffective

for one participant (Shannon). Additional con-sequences were added to her IST. If she correctlyprotected herself from the stranger on the firsttrial of the session, a variety of games and stickerswere available when she and the experimenterreached their destination. However, if she did notcorrectly protect herself, the experimenter im-plemented ISTuntil she responded appropriatelyand without prompts. When the participant andexperimenter reached their destination, theexperimenter chose a toy and Shannon did notreceive a sticker.Maintenance. Available participants complet-

ed in situ assessments 8 weeks after their previousin situ assessment. If participants respondedcorrectly, the experimenter delivered descriptivepraise. Incorrect responses were followed by IST.Treatment extension. During the treatment

extension, the kindergarten class went to aplayground. While there, one of the two regularclassroom teachers separated the participant fromthe group for a fitness test (e.g., measuring howfar the participant could jump). When theparticipant and teacher were about 5m awayfrom other children and adults, the teachercommented on how she forgot an item (e.g., the

measuring tape) and left the participant alone toretrieve the forgotten item. At this point, theassessment continued as described previously.One of the confederate strangers casuallyapproached the participant shortly after theteacher left and asked the participant to leavethe area (e.g., “Let’s play over here.”). The teacherprovided enthusiastic descriptive praise if theparticipant got away and told a safe adult aboutthe stranger. If the participant did not respondcorrectly, ISTwas implemented.

Results and DiscussionCBSTwas completed in an average of 19min

across participants (range, 14 to 23min). Dura-tion varied across participants because a setnumber of correct responses per module wasrequired to move through the program.Figure 2 displays the data from the in situ

assessments conducted during Study 1. None ofthe 11 participants protected themselves inbaseline. Although baselines for some partic-ipants were very short, previous research suggeststhat children do not learn to protect themselvesin the absence of training (e.g., Beck &Miltenberger, 2009; Dancho et al., 2008; Mil-tenberger et al., 2004, 2005; Poche et al., 1981).Nine of the 11 participants acquired the safetyskills after CBST and IST. One participantresponded correctly after CBSTalone. One otherparticipant required additional consequences torespond correctly during the in situ assessment.By the end of the study, all participants movedquickly away from the stranger and reported to anadult. Safety skills were maintained for four offive participants who were available for an 8-weekfollow-up observation. Furthermore, when astranger approached a participant at a playgroundinstead of in the hallway at school, generalizationof the safety skill to the new location was observedfor 8 of the 11 participants. Target responses weresubsequently acquired in the new location for thetwo participants for whom effects of IST wereevaluated in the second location. Shannon wasunavailable for the second day of assessments at


Figure 2. Data for the 11 participants in Study 1 (abduction prevention). Circled data points indicate sessions with insitu training. Bsl¼ baseline; CBST¼ computerized behavioral skills training; IST¼ in situ training.


the playground; therefore, the effects of IST inthe new location could not be determined.

STUDY 2: POISON AND LIGHTERSAFETY

Study 1 suggested that CBSTand ISTresult inthe acquisition of safety skills, maintenance overtime, and generalization to new settings, but itincluded only a single danger. The purpose ofStudy 2 was to determine whether safety skillswould generalize across dangers when IST wasprovided for only a single danger. Two additionaldangers were evaluated in Study 2: poisons andlighters. Study 2 also explored a possiblelimitation of the CBST program, which iserroneous feedback by the computer during theAct Out component. Because the computerprogram could not detect the participants’ actualbehavior of running away and telling an adult,feedback was based on the time between thestranger’s appearance on the screen and the clickof a button. In Study 2, we compared thecorrespondence between human observers’ datacollection and computer-recorded responsesduring the Act Out game, because these datawere not collected in Study 1.

Participants and SettingThe same 12 children who began participation

in Study 1 participated in Study 2. All parti-cipants had learned to say “no,” get away, and tellan adult when approached by a stranger duringStudy 1. Samantha, who did not want toparticipate in Study 1, learned the safety skillsregarding strangers outside the experimentalanalysis. She opted to participate in Study 2.All in situ assessments occurred in a small

room. The experimenter observed participantsvia a wireless video monitor placed in theroom.

DesignThe experimental design was similar to that

used in Study 1 except that in situ assessments

were conducted for poisons and lighters ratherthan strangers. Both lighter and poison in situassessments were conducted during baseline sothat generalization could be assessed after thecomputer game or after IST with one of thedangers. CBST included instruction on all threedangers: strangers, poisons, and lighters. ISTwasimplemented only for lighters if the participantmade errors during the in situ assessment afterplaying the computer game. CBSTand ISTwereimplemented according to a concurrent multiplebaseline design. An extended phase in which noISTwas conducted after the computer game wasnot included in Study 2. Participants played thecomputer game only once before IST for lightersbegan.

Data CollectionData collectors observed the participant via a

wireless camera and monitor. They recordedwhether a participant touched the danger, left theroom, or reported the danger to the experimenter(see Table 1). Interact with the danger was scoredany time the participant touched the danger(lighter or poison) with any body part. Stay nearincluded any time the participant did not touchthe danger, get away, or tell an adult.Get awaywasscored if any part of the participant’s body crossedthe threshold of the room’s doorway within 10 safter entering the room with a danger. The samecriteria for Study 1 were used for tell an adult.Human observers scored the participant’s

responses during the Act Out game. For eachtrial, a response was scored correct if theparticipant moved within arm’s reach of thecardboard cutout and reported the danger within5 s of the danger appearing on the computerscreen.Interobserver agreement was calculated for an

average of 33% of in situ assessments (rangeacross participants and phases, 20% to 43%) and50% of Act Out game sessions. Agreement wascalculated the same way as in Study 1. Agreementfor the in situ assessments was 100% for allsessions. Agreement for the Act Out game


sessions was also calculated using trial-by-trialagreement (i.e., an agreement was scored whenboth observers recorded a correct or an incorrectresponse on the same trial). Agreement betweenhuman observers for the Act Out game averaged95% (range, 85% to 100%).

ProcedureIn situ assessment. The in situ assessment

began when the participant was alone in thesession room. As in the stranger assessment, theexperimenter left the participant alone while heleft to get something or take a phone call. Then,the experimenter left the session room andobserved the participant via a video monitor.The participant encountered the danger In theroom. During the lighter assessment, a disabledlighter (i.e., with gas and flint removed) wasplaced near some toys on the table. During thepoison assessment, before the participant enteredthe room, the experimenter mentioned that therewas a cookie the participant could eat. A cookiewas on the table, and fake poisons were nearby.For this assessment, the poisons were pill-shapedcandy placed inside a variety of medicinecontainers, a procedure modeled after that ofDancho et al. (2008). If the participant left theroom within 10 s and reported the danger to theexperimenter, the experimenter provided enthu-siastic descriptive praise. The duration to exit theroomwas extended to 10 s, compared to 5 s in thestranger assessment, because it was difficult todetermine when the participant noticed thedanger. If the participant interacted with thedanger or did not leave the room within 1min,the experimenter entered the room and noncha-lantly removed the danger. The experimenterentered the room when a participant interactedwith the danger to limit the amount of time he orshe could practice dangerous behavior (e.g.,opening a pill case or playing with a lighter).During the baseline in situ assessment, correctivefeedback and rehearsal did not occur for eitherdanger if an error was made (e.g., trying to openthe medicine container).

Computerized behavioral skills training (CBST).The computer game was similar to that describedin Study 1 except that participants learned aboutstrangers, poisons, and lighters. Table 2 summa-rizes the games and indicates differences from thegame in Study 1. Participants completed the ActOut component for three correct trials for eachdanger, and at the end of the program, the ActOut game was repeated for six correct trials with adifferent danger for each trial. As in Study 1, atotal number of correct trials were required toprogress through the modules instead of a setnumber of trials. Each danger was taughtseparately until the last Act Out game in whicha different danger was presented in each trial.The ActþRun! game was removed from this

version of the computer program. Two new click-based games were added to teach the new dangersand to promote discrimination between safe andunsafe situations. In one game, a variety ofpictures were displayed on the screen. Some ofthe pictures contained dangerous items (i.e.,poisons or lighters). The participant was requiredto sort the pictures into a “safe” and an “unsafe”box. In a second game, a single picture wasdisplayed on the screen. If the picture contained adanger, the participant clicked a red button tomake an animated stick figure get away from thedanger. If the picture displayed a safe item (e.g.,toys only), the participant clicked a green buttonand the animated stick figure approached thepicture.An error screen was added to the Act Out game

that prompted the participant to recruit helpfrom a teacher if he or she made three consecutiveerrors. During the game, a screen appeared withinstructions to find a teacher and ask for help.The experimenter was required to hold downthe control key and type T on the keyboard tocontinue the program. On the next trial, theexperimenter watched the participant during thetrial and provided vocal and model prompts untilhe or she correctly emitted the safety response.In situ training (IST). IST was implemented

only for the lighter danger. ISTwas similar to that


in Study 1 except that after receiving feedback,the experimenter and participant left the roomand the experimenter then sent him or her backinto the room to initiate another trial. Trials wererepeated until the participant got away from thedanger and reported the danger to the experi-menter without any prompts. Usually, one or twotrials were conducted per session.

Results and DiscussionAfter CBST for all dangers and IST for a single

danger (lighters), participants protected them-selves from both dangers (lighters and poisons)included in the computer game. Figure 3 displaysthe results of Study 2. Amy and Dana correctlyprotected themselves from poisons and lightersafter CBSTwithout experiencing IST for either.IST was not used for these participants becausethey responded correctly to the dangers duringtheir first in situ assessment after CBST. Therewere two other patterns of acquisition for otherparticipants. Four participants’ performancegeneralized across dangers after they receivedonly one session of IST for a single danger. Inother words, the generalized effects of IST wereapparent during the poison assessment before theparticipant demonstrated appropriate self-protec-tion for lighters. Five participants’ self-protectionskills did not generalize to poisons until theyprotected themselves independently against light-ers. Most participants required only one or twosessions of IST on one danger before protectingthemselves independently against both dangers.Two participants, Neal and Mike, required threesessions of IST for lighters before correctperformance occurred consistently in the pres-ence of lighters and poisons. Thus, safety skillsgeneralized to poisons after IST for lighters for allparticipants. IST for poisons was not required.CBST was brief and required only minimal

experimenter interaction. The mean duration forCBST across participants was 20min (range, 17to 28min). In Study 2, only one participantrequired additional assistance after making threeconsecutive errors in the first Act Out module

with strangers. The assistance occurred in onetrial that lasted 28 s. The experimenter vocallyprompted the participant to get out of her chair,walk over to the cardboard cutout, and tell thecardboard cutout about a stranger she saw on thescreen. After the brief prompt, the participant waspraised by the on-screen narrator and continuedto emit the correct safety skills in the presence ofthe on-screen dangers.Even without motion-detection hardware and

cameras, the computer game accurately providedfeedback to participants who did and did not actout the safety skills. During CBST, a humanobserver recorded whether a participant correctlyemitted the safety skills (get away and tell anadult). The computer program recorded a correctresponse if the delay between the video of thedanger and the participant clicking the “OK”button to continue to the next trial was greaterthan 4 s. Trial-by-trial agreement between thecomputer game and the primary human observeraveraged 89% (range, 71% to 100%). Scoresbetween the two types of observers were wellcorrelated for 11 of the 12 participants. In otherwords, the computer program provided accuratefeedback to participants about their Act Outperformance. The computer program recorded amuch higher percentage correct than the humanobserver did for Darla. Darla waited 4 s beforeclicking “OK”without acting out the appropriateskills. Overall, feedback was fairly accurate, andDarla and all the other participants learned toprotect themselves against the dangers quicklyeven after they experienced erroneous feedbackduring the computer game.Performance on the computer game was not

correlated with success during the in situassessment. More specifically, the percentagecorrect during the role-play component of thecomputer program (based on human observations)and the duration spent playing the computer gamewere not significantly correlated with the numberof IST sessions required before the participantemitted the correct safety skills, r(10) ¼ �.21,p ¼ .51 and r(10) ¼ .26, p ¼ .41, respectively.


Figure 3. Data from poison and lighter in situ assessments for 12 participants in Study 2. Circled data points indicatesessions with in situ training. Bsl¼ baseline; CBST¼ computerized behavioral skills training; IST¼ in situ training.


Like knowledge assessments, performance duringrole-plays, or in this case, computer simulations,is not a good indicator of performance inother settings and should not be used to makedecisions regarding mastery of important safetyskills.These data suggest that the combination of

CBST and IST for a single danger may be aneffective technology for developing a compre-hensive safety skills program in which childrencan be taught to protect themselves from a varietyof dangers. However, the participants in Study 2had prior experience with the computer programand learning to protect themselves from strangersbefore Study 2 began. It is therefore unclear howmany dangers need to be taught using CBSTandIST before performance begins to generalize toother dangers experienced only in the computergame.

STUDY 3: COMPREHENSIVE SAFETYSKILLS PROGRAM

The purpose of Study 3 was to determine theextent to which performance would generalizeacross dangers for children who had not learnedto protect themselves from strangers.

ParticipantsParticipants were four 5- and 6-year-old

children from a kindergarten classroom at aschool in Massachusetts. Participants in Study3 did not have any prior experience with the insitu assessments or the computer game for anydanger.

Data Collection and Interobserver AgreementData on in situ assessment performance were

collected in the same manner as in Studies 1 and2. Interobserver agreement was obtained aspreviously described during 27% of in situassessment sessions across participants and con-ditions (range, 25% to 28%). Interobserveragreement was 100% for all in situ assessmenttypes (strangers, lighters, and poisons).

ProcedureIn situ assessments for strangers, lighters, and

poisons were identical to those described inStudies 1 and 2. The computer game was thesame game from Study 2, which taught theparticipant about strangers, lighters, and poisons(see Table 2). As in Study 2, assistance wasprovided by the experimenter if the participantmade three consecutive errors during one of theAct Out games.CBST was implemented according to a

concurrent multiple baseline design. AfterCBST, IST was implemented for lighters if theparticipant did not protect him- or herself duringin situ assessments. If the participant did notrespond correctly in the other in situ assessments(poisons and strangers) after responding correctlyto lighters in at least one session, the participantreplayed the computer game before IST wasinitiated for an additional danger.

Results and DiscussionDuring baseline, none of the participants

protected themselves sufficiently (Figure 4). Allparticipants interacted with at least one of thedangers. Andrea reported the stranger after theexperimenter returned, but did not get away fromthe stranger and instead spoke with him until hewalked away. Although this was not as dangerousas immediately going with the stranger, stayingnear allows the stranger more time to convincethe child to comply with his request. After CBST,Tammie protected herself from poisons andlighters without any additional training. Theremaining three participants protected them-selves from both poisons and lighters after theyreceived IST for lighters. Safety skills did notgeneralize from poisons and lighters to strangersfor any of the participants; however, after theyexperienced IST for one (Tammie, Andrea, andDarcy) or two (Danny) sessions, all participantsgot away from the stranger and reported him orher to a safe adult.Study 3 replicates the findings of Studies 1 and

2: CBST was an efficacious replacement for


teacher-conducted BST for safety skills. ISTwas,however, still necessary for at least some of thedangers for most of the participants.CBST remained brief, but required slightly

more experimenter intervention than in Study 2.Three of the four participants required briefintervention during the computer program afterthey made three consecutive errors during thefirst Act Out game with strangers. The averageduration of assistance was 35 s (range, 33 to 38 s).The experimenter provided brief vocal prompts

for the participants to walk over to the cardboardcutout and tell it about the stranger on thecomputer screen. Although some interventionmay be required for some participants, theamount of assistance is much less in thantraditional forms of BST, which requires theteacher to conduct the entire rehearsal andfeedback component for each child. DuringCBST, our data suggest that assistance may beneeded for less than 1min and only for somechildren.

Figure 4. Data from poison, lighter, and stranger in situ assessments for four participants in Study 3. Circled data pointsindicate sessions with in situ training. CBST¼ computerized behavioral skills training; IST¼ in situ training.


The overall duration of the computer programwas similar to that observed in Study 2. Theaverage duration across participants was 24min(range, 19 to 27min) on the first attempt beforeIST with lighters and 22min (range, 20 to23min) on the second attempt before IST wasimplemented in the stranger context. Unliketeacher-directed BST, CBST does not increase induration as the number of participants increasesbecause the role-play component can runsimultaneously for multiple participants whileindividualized feedback is maintained. In addi-tion, multiple dangers can be presented digitallyrather than requiring additional physical materi-als to teach each danger.Safety skills generalized from lighters to

poisons but did not extend to strangers in Study3. All four participants responded safely during insitu assessments for lighters and poisons afterplaying the computer game (which included allthree dangers) and experiencing IST only forlighters.Tammie acquired safety skills with respect to

poisons and lighters with only computer-basedsimulations (i.e., without IST); by contrast, ISTwas required for her to protect herself fromstrangers. The different features of strangers andinanimate dangers and differences in the child-ren’s histories with respect to these stimuli mayhave led to limited generalization between thetwo types of dangers.

GENERAL DISCUSSION

The current studies suggest that computerizedsafety skills training combined with ISTmay bea viable alternative to more intensive training(e.g., BST and IST conducted by a teacher)and that safety skills may generalize betweenspecific subsets of dangers. All of the parti-cipants acquired poison, lighter, and strangersafety skills after they played a safety skillscomputer game and experienced IST, and thesesafety skills generalized across specific subsets ofdangers.

Understanding the conditions under whichself-protection generalizes to other dangers andthe limits of generalization will allow thedevelopment of an efficient, efficacious, andcomprehensive safety skills program. It may bethe case that IST is required for only oneof multiple dangers that share functionalsimilarities, whereas additional IST is requiredfor functionally distinct dangers. The similarstimulus conditions and reinforcement historiesassociated with poisons and lighters may havepromoted generalization. In both the poisonand the lighter assessments, the participantentered the room alone and discovered thedanger on a table near toys or next to somethingedible. In addition, participants likely had alimited reinforcement history for interactingwith poisons and lighters. Parents likely do notencourage their children to touch lighters oropen pill cases. Some parents may have punishedprior instances of playing with lighters. The clearstimulus conditions and limited learning histo-ries with respect to poisons and lighters mayhave promoted generalization.However, generalized responding did not

extend to the stranger in situ assessment inStudy 3. IST was required for strangers beforesafety skills in that situation emerged. The lackof generalization from lighters to strangersmay not be unexpected given the differentstimuli and reinforcement histories associatedwith each danger. The poison and lighter in situassessments contained stimuli that children donot experience on a regular basis; however,children frequently interact with a variety ofpeople throughout the day. The discriminativestimuli associated with strangers are moredifficult to detect than poisons or lighters.Strangers can have a variety of appearances,and children must detect whether a personwho asks them to leave is a known adult;responding must be sensitive to conditionaldiscriminations about receiving or not receivingprior permission to leave with the person from ateacher or parent.


Beyond the difficult conditional discrimina-tion, the reinforcement histories associated withcomplying with an adult’s request may inhibit thedevelopment of safety skills. Children are oftenrequired to comply with requests from peoplewith whom they are unfamiliar at school (e.g., anadult, who is not the regular classroom teacher, isin charge of transitions from the classroom to thebus). Compliance to these adults’ instructions isexpected. In addition, children are often praisedfor being outgoing and social with important, butunfamiliar, visitors. Both of these contingenciesprobably create a reinforcement history that runscounter to the training self-protection fromstrangers.Future research should be directed towards

determination of the natural histories that giverise to functional classes of dangers (i.e., thosedangers for which training self-protection on oneleads to effective performance with respect to theothers). Future research should also be directedtowards determination of the types of teachingmethods that will lead to the formation of largerfunctional classes of dangers to maximizegeneralization across dangers and minimize theextent to which IST is required to build aneffective repertoire of self-protection. For in-stance, it is possible that stronger stimulus-equivalence-based programming (Sidman &Tailby, 1982) might yield functional classes ofdangers. Teaching a child to protect him-or herself from one of these functionallyequivalent dangers via IST may yield improvedgeneralized performance with respect to the otherdangers.Perhaps, instead of considering the different

functional classes, researchers might identifysimilar stimulus conditions across all dangeroussituations. Palaez, Virues-Ortega, and Gewirtz(2012) taught infants to attend to their mother’sfacial expression before they interacted withambiguous objects. Children might be taught todiscern a wide range of ambiguous stimuli (e.g.,food or drinks that are novel or unlabeled or aperson who the child has not met before) and

check with an adult before interacting withambiguous people or objects.Compared to previous research on BST, the

current series of studies suggest that CBSToutcomes may be similar to those for traditionalBST, in that BSTalone may not be effective for allparticipants but is effective when used incombination with IST (Dancho et al., 2008;Himle, Miltenberger, Gatheridge, & Flessner;2004). Future researchers might directly comparethe relative efficacy and efficiency of, and childand caregiver preference for, BST and CBST.In the current analysis, the necessity of CBST

prior to IST cannot be determined, because ISTwas never conducted without prior CBST.However, previous data suggest that IST maynot be as effective without BST. For example,Beck and Miltenberger (2009) implemented ISTfor stranger safety after participants watched acommercially available video program. Two ofthe six participants required a session of BSTbefore they consistently performed the correctsafety skills, even though IST had been in place.Although it was not the primary conclusion oftheir study, the data suggest that the combinationof BSTand ISTmay be more effective than eithercomponent separately. In addition, it seemsunlikely that ISTwould be implemented withoutfirst teaching children about the dangers they arelikely to encounter.It is important to note that four participants

acquired safety skills after they experienced onlyCBST. Although current research does notsuggest what the key repertoires may be, it ispossible that repertoires that promote generaliza-tion between a computer and another situationare acquired due to the widespread use ofcomputer-based learning in schools and homes.Researchers should attempt to identify variablesthat influence this sort of generalization. Evalu-ating the current CBST program with olderchildren, who likely have acquired relevantrepertoires for generalization, is also an importantnext step in determining the efficacy of computerprograms to teach safety skills. Safety skills


programs for older children are especially impor-tant because those children are more likely to beleft without direct parent or teacher supervision.

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Received February 11, 2013Final acceptance October 16, 2013Action Editor, Anna Petursdottir


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http://www.cdc.gov/injury/wisqars/LeadingCauses.html

http://nces.ed.gov/pubs2001/overview/table05.asp

http://nces.ed.gov/pubs2001/overview/table05.asp

an evaluation of computerized behavioral skills training to teach safety skills to young children

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