A Multiple Baseline Evaluation of Training Medical Residents In Indirect Functional Behavior Assessment Procedures: A Proposed Study

Philadelphia, PA

INTRODUCTION: Pediatric primary care is a critical access point for children’s behavioral and developmental health needs. Families commonly turn to pediatricians for guidance when behaviors interfere with learning or family well being. Behavioral concerns are frequent in these settings; however, many pediatricians report feeling unprepared to give direct and effective behavioral advice. Pediatricians have the opportunity to identify and intervene early for children with behavioral concerns. Training in residency has historically emphasized biomedical explanations that can overlook the environmental factors influencing behavior. Without the practical tools for understanding why behavior occurs, preventative intervention may be missed. There is a continued growing need for efficient, evidence-based approaches that guide pediatric providers in interpreting behavior functionally to strengthen anticipatory guidance and provide better support for families within a pediatric visit.

Objectives: The purpose of this study is to evaluate a structured training program, grounded in principles of behavioral skills training, aimed at strengthening pediatric residents’ ability to approach behavioral concerns using functional assessment methods. Additionally, this study examines residents’ application of functional reasoning to identify behavioral function and provide clear, feasible recommendations to caregivers during routine visits.

METHODS: A multiple baseline across skills design will be used to evaluate the effects of the virtual behavior skills training modules on indirect functional behavior assessment skills, function identification and recommendation skills. Medical residents will complete training modules and brief virtual probe sessions in which they respond to standardized caregiver vignettes depicting common behavioral concerns in pediatric primary care. Training will be delivered through self-paced modules within the DigiTeck learning management system and will follow a behavioral skills training framework including instruction, modeling, rehearsal and feedback. Residents will submit structured written or recorded responses that serve as permanent products and will be scored using standardized rubrics. Self-reported confidence and comfort will also be collected following probe activities.

RESULTS: Data will be analyzed using visual inspection consistent with single case methodology. Performance for each resident will be graphed across baseline and intervention phases for indirect functional behavior interviewing skills, function identification, and function-based advice. Changes in level, trend, variability, and immediacy of effect will be examined as each skill is introduced in a staggered sequence if mastery or stability criteria is met. Experimental control will be supported if improvement occurs following training while other skills remain stable. Resident confidence and comfort ratings will be summarized descriptively across phases.

CONCLUSION: Findings from this study are hypothesized to demonstrate whether a brief, virtual behavioral skills training model can improve how residents understand and respond to behavioral concerns in pediatric primary care. Results may inform practical, evidence-based residency training, strengthening early intervention, improving referral precision, and increasing provider readiness to deliver function-based guidance during routine visits.