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The experiences of behaviour interventionists who work with children with autism : occupational stress,… Elfert, Miriam 2003

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THE EXPERIENCES OF BEHAVIOUR INTERVENTIONISTS WHO WORK WITH CHILDREN WITH AUTISM: OCCUPATIONAL STRESS, COPING, AND FAMILY AND CHILD VARIABLES by MIRIAM ELFERT B A . (Honours), Simon Fraser University, 1998  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES (Department of Educational Psychology and Counselling Psychology, and Special Education) We accept this thesis as conforming ""TOjthe  required standard  THE UNIVERSITY OF BRITISH COLUMBIA August, 2003 © Miriam Elfert, 2003  In presenting this thesis in partial fulfilment  of the requirements for an advanced  degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department  or by his or her representatives.  It is understood  that copying or  publication of this thesis for financial gain shall not be allowed without my written permission.  Department of The University of British Columbia Vancouver, Canada Date  DE-6 (2/88)  <j^pV-  /I \Q3  <^ ^ ]  c^Jl  ^Ld^C* Uo^  Abstract There has been no published research on the people who work intensively with children with autism. The present study was conducted to explore the experiences of Behaviour Interventionists (Bis) who provide one-to-one intervention to children with autism in families' homes. A number of variables were examined, including occupational stress; the relation among stress, strain, and coping; the relation of stress to characteristics of (a) challenging families and (b) children with autism to whom Bis provide support; most and least rewarding aspects of the job; and training and support needs. A total of 65 participants from organizations providing intervention to children with autism in British Columbia and Alberta took part in the study. The two most stressful work roles for Bis were Role Overload (the extent to which job demands exceed personal and workplace resources) and Role Boundary (the extent to which the individual experiences conflicting role demands and loyalties at work). Significant relations were found between stress and coping, and between strain and coping. Coping, however, was not found to moderate the relation between stress and strain. Statistical analyses indicated that there were no correlations between BI stress and characteristics of challenging families to whom Bis provide support. Significant correlations were found between BI stress and two groups of behaviours exhibited by children with autism—sensory-related behaviours and social unrelatedness. The most rewarding aspects of Bis' work pertained to child variables such as helping the child learn and make progress. The most stressful aspects of Bis' work pertained to job variables such as isolation of the job and time pressure. Bis indicated that there were a number of training and support needs, such as increased supervision and support by senior staff, and training on how to deal with difficult parents/family issues. The results are discussed in terms of their clinical and research implications, limitations, and suggestions for future research.  Ill  TABLE OF CONTENTS Abstract Table of Contents List of Tables  ii iii v  Acknowledgements  vii  CHAPTER 1: INTRODUCTION AND REVIEW OF THE LITERATURE  01  The Study Pervasive Developmental Disorders Autistic Disorder (Autism) Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS)... Asperger's Disorder Early Intervention in Autism Behaviour Interventionists Stress and Coping of Bis Research on Home Visiting Research on Stress in Home Visiting Summary of Stress in Home Visiting Criticisms of Research on Stress in Home Visiting Research on Coping Resources in Home Visiting Summary of Research on Coping in Home Visiting Criticisms of Research on Coping in Home Visiting Theories of Stress and Coping Proposed Research  01 02 02 04 04 04 07 10 14 16 23 25 27 32 33 33 36  CHAPTER 2: METHOD  38  Participants Settings Measurement Pilot Project Instrumentation Procedure Consent Procedures and Ethical Review Data Collection Research Questions, Hypotheses, and Data Analyses  38 40 41 41 42 51 51 51 52  CHAPTER 3: RESULTS  62  iv Determination of the Impact of Demographic and Training Differences Across Sites Analysis of Data Pertaining to the Research Questions Question #1: What specific work roles, as measured by the ORQ of the OSI-R (Osipow, 1998), are rated by Bis as being most stressful? Question #2: Are there significant correlations between Bis' occupational stress, as measured by the ORQ of the OSI-R, and the 10 subscale scores on the FES that describe specific characteristics of the "challenging" families with whom they work? Question #3: Are there significant correlations between Bis' occupational stress, as measured by the ORQ of the OSI-R, and the five subscale scores on the ABC that describe behavioural characteristics of a child with autism? Question #4: What is the relationship between stress (as measured by the ORQ of the OSI-R), strain (as measured by the PSQ of the OSI-R), and coping (as measured by the PRQ of the OSI-R)? Question #5: What do Bis perceive to be the least and most and least enjoyable aspects of their work? Question #6: What additional training and support do Bis believe they need to be more competent, skilled, and successful in their work? CHAPTER 4: DISCUSSION Work Roles ORQ and Family Environment Scale Correlations ORQ and Autism Behavior Checklist Correlations Stress, Strain, and Coping Limitations of the Study Implications of the Study Future Research Conclusion  62 65 65  67 68 69 71 81 87 87 90 92 96 97 99 101 102  REFERENCES  104  APPENDICES  109  V  LIST OF TABLES Table 1:  Number of Eligible and Actual Participants Recruited by Site  39  Table 2:  Means, Standard Deviations, and Ranges for Initial and Ongoing Training for Participants  Table 3:  Intercoder Reliability for Question #1 ("What do you feel is/are the most challenging or stressful aspects of your job as a BI")  Table 4:  41  59  Intercoder Reliability for Question #2 ("What do you feel is/are the most rewarding or enjoyable aspects of your job as a BI?")  Table 5:  60  Intercoder Reliability for Question #3 ("Please describe any additional training and/or support that would help you to be more successful, skilled, competent, etc: in your work.")  Table 6:  Means and (Standard Deviations) for Key Participant Demographic Variables  Table 7:  61  63  Correlations Among Demographic Variables and Stress, Strain, and Coping Scores  64  Table 8:  Means and Standard Deviations for the OSI-R Subscales  65  Table 9:  Tukey Pairwise Comparisons Between Work Role Scores on the OSI-R  66  Table 10:  Correlations Between FES Subscale Scores and ORQ Total Scores  68  Table 11:  Correlations Among Stress (ORQ), Strain (PSQ), and Coping (PRQ) Scores..70  Table 12:  Frequency Count and Percentages of Written Responses to Question #1 ("What do you feel are the most challenging or stressful aspects of your job asaBI?")  72  vi  Table 13:  Representative Examples of Responses Regarding the Most Stressful or Challenging Aspect(s) of Bis' Work  Table 14:  76  Frequency Count and Percentages of Written Responses to Question #2 ("What do you feel is/are the most rewarding or enjoyable aspects of your job as a NIT)  Table 15:  '.  Representative Examples of Responses Regarding the Most Rewarding or Enjoyable or Challenging Aspect(s) of Bis' Work  Table 16:  78  80  Frequency Count and Percentages of Written Responses to Question #3 ("Please describe any additional training and/or support that would help you to be more successful, skilled, competent, etc. in your work.")  Table 17:  82  Representative Examples of Responses Regarding Additional Training and Support Needs of Bis  86  Vll  ACKNOWLEDGEMENTS A warm and heartfelt thank you to my tireless supporter, cheerleader, and advocate, Dr. Pat Mirenda, whose unwavering commitment and effort helped bring this project to fruition. You are a dedicated and inspirational teacher, and I have learned so much from you. We did it Lady! To Drs. Joe Lucyshyn and Kim Schonert-Reichl: Thank you for being on my committee, lending me your support, and providing me with new insights into my research. And thank you Kim and Arlie for giving me some additional input on my final draft. Thank you also to Drs. Bruno Zumbo and Marshall Arlin for their statistical consultation. To those Bis who participated in my study and the organizations that helped me recruit them: Thank you for so candidly sharing your frustrations and your inspirations. I truly hope this information will lead to improved support/training for this special group of service providers. You really do make a difference in the lives of the children and families with whom you work. To my friends, particularly those in the Master's program, thanks for supporting me through the laughter and the tears, and spending those many hours talking to me on the phone. At the most crucial times, those talks were a source of comfort, reassurance, and optimism. To Mom and Dad: You taught me to always work hard and achieve my goals. You have been my models of effort, endurance, and strength. Thank you for your continual encouragement and support of my academic achievements. (Mom—you can finally give me my gift!) Finally, to RG: You knew when to make me laugh, when to comfort me, when to offer your wisdom, and when to let me struggle on my own. You maintained a healthy balance, which helped keep me balanced. Thank you for always listening to, encouraging, and supporting me. You're a wonderful partner. On to the next Master's degree!  Experiences of Interventionists  \  CHAPTER 1 . Introduction and Review of the Literature This chapter will begin by briefly outlining the purpose of the proposed study. It will then describe the characteristics of the Pervasive Developmental Disorders (PDDs). This will be followed by a discussion of the role of behaviour interventionists who work with children with Autism Spectrum Disorder (ASD) in families' homes, including the interventionists' workrelated stressors and coping resources. The term Autism Spectrum Disorder refers to the range of disorders that fall within the autism spectrum, including Asperger's Syndrome and Autistic Disorder (i.e., autism). The term will be used in this paper to denote this broader autism spectrum. Finally, the literature on stress and coping in home visiting will be presented, followed by a rationale for this study, including the research questions and hypotheses that guided this research. The Study  The purpose of this study was to gather information about behaviour interventionists who work on a one-to-one basis with children with ASD in the children's homes. To date, there has been no published research examining the experiences of behaviour interventionists, a group of paraprofessionals who play an important role in the lives of many children with ASD and who are increasingly growing in number. This exploratory study utilized a combination of quantitative and qualitative research methodologies to examine interventionists' experiences. Empirical information was gathered on behaviour interventionists' occupational stress, psychological strain, and coping resources. The study also examined their perceptions of a challenging or difficult family with whom they worked and the behavioural characteristics of a child with ASD with whom they worked. Finally, the study documented the most and least  Experiences of Interventionists  2  enjoyable aspects of behavior interventionists' work, as well as their reports about work-related training and support. The following section will begin by describing the characteristics of the Pervasive Developmental Disorders, a category of disorders in which autism is a member. Pervasive Developmental Disorders  The Pervasive Developmental Disorders (PDD) are characterized by severe and pervasive impairment in several areas of development: reciprocal social interaction skills, communication skills, and/or the presence of stereotyped behaviour, interests, and activities (APA,  2000).  The  three main PDDs are Autistic Disorder, Pervasive Developmental Disorder-Not Otherwise Specified, and Asperger's Disorder. Autistic Disorder (Autism)  Autism is a PDD characterized by significant impairments in social interaction and communication, as well as repetitive or stereotyped patterns of behaviour, interests, and activities (APA,  2000).  In order to meet the criteria for Autistic Disorder, an individual must display six or  more of the symptoms described in the DSM-IV-TR,.as outlined below: 1.  Qualitative impairments in reciprocal social interaction, as manifested by at least two of the following: (a) Marked impairment in the use of multiple nonverbal behaviours such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction; (b) Failure to develop peer relationships appropriate to developmental level; (c) A lack of spontaneous seeking to share enjoyment, interests, or achievements with others; and (d) Lack of social or emotional reciprocity.  2.  Qualitative impairments in communication, as manifested by at least one of the following:  Experiences of Interventionists  3  (a) A delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime); (b) In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others; (c) Stereotyped and repetitive use of language or idiosyncratic language; and (d) Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level. 3.  Restricted, repetitive, and stereotyped patterns of behaviour, interests and activities, as manifested by at least one of the following: (a) Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus; (b) Apparently inflexible adherence to specific, nonfunctional routines or rituals; (c) Stereotyped and repetitive motor mannerisms such as hand or finger flapping, or complex whole body movements; and (d) Persistent preoccupation with parts of objects.  In addition to these criteria, a diagnosis of autism requires delayed or abnormal functioning prior to age three in at least one of the following areas: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play. The onset of autism occurs prior to the age of three, and the incidence is estimated to be 5 cases per 10,000 individuals, with reported rates ranging from 2 to 20 cases per 10,000 individuals (APA, 2000). Autism occurs four to five times more frequently in males than in females (APA, 2000).  Experiences of Interventionists ' 4  Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS)  In the DSM-IV-TR, the category PDD-NOS is used when there is a severe and pervasive impairment in the development of reciprocal social interaction associated with impairment in either verbal or nonverbal communication skills, or with the presence of stereotyped behaviours, interests and activities, but the criteria are not met for a specific PDD (APA, 2000). Because of changes in diagnostic criteria in the DSM over the years, the prevalence of PDD-NOS is unclear (Towbin, 1997). Asperger's Disorder  Asperger's Disorder is characterized by severe and sustained impairments in social interaction, and the development of restricted, repetitive patterns of behaviour, interests, and activities (APA, 2000). Furthermore, there must be significant impairment in social, occupational, or other important areas of functioning. However, unlike Autistic Disorder, there are no significant delays or deviance in language acquisition, although pragmatic aspects of communication may be affected (e.g., difficulty understanding typical give-and-take in conversation). There are also no significant delays in cognitive development, or in the development of age-appropriate self-help skills, adaptive behaviour, and curiosity about the environment in childhood. Conclusive data about the prevalence of Asperger's Disorder are lacking (APA, 2000): However, a recent study by Ehlers and Gillberg (1993) estimated the minimum prevalence rate to be 3.6 per 1,000 individuals. The disorder is diagnosed at least five times more frequently in males than in females (APA, 2000). Early Intervention in Autism  Over the past three decades, significant advances have been made in the field of intervention for individuals with ASD. In particular, there is growing recognition of the  Experiences of Interventionists 5  importance of providing early intensive intervention to young children with ASD (Dawson & Osterling, 1997; Whiteford Erba, 2000). Some of the advantages of providing early intervention include the acquisition of social-communication skills at a critical time in a child's development; improved collaboration with families; and early detection and treatment of challenging behaviours (Dunlap & Fox, 1996). A number of early intervention models for children with ASD have been described and empirically examined in the literature (e.g., Dawson & Osterling, 1997). These various models represent a continuum of approaches, ranging from interventions based on principles of Applied Behaviour Analysis (ABA) to interventions influenced by social pragmatic developmental theories (Prizant & Wetherby, 1998). One of the most well known and well- researched models was pioneered by Dr. O. Ivar Lovaas in the 1970s, and is based upon the principles of ABA. Lovaas (1987) conducted a significant study in which one-to-one intervention was provided to young children with autism (under the age of four) who were assigned (not randomly) to three groups for a period of 2 years: (a) 40 hours of treatment per week, (b) 10 hours of treatment per week, and (c) no treatment. The treatment was based on reinforcement (operant) theory, and consisted of one-to-one instruction provided to the child by trained student therapists, as well as parents and teachers. The treatment focussed on rewarding, punishing, and shaping the child's behaviours. It also focussed on teaching the child a variety of skills such as sitting, attending, imitating, matching, playing, and following adult instructions. The results indicated that 9 of the 19 children (47%) in the 40-hour per week treatment group were able to complete first grade in regular classes without any support, and achieved IQ scores in the "normal" range. The children who received 10 hours per week of intervention and the children in the no treatment group were grouped together in the reporting of the results. This group of children also made gains, but to a  Experiences of Interventionists  6  lesser degree: Only 2% (n = 40) achieved normal educational and intellectual functioning. This was a seminal piece of research in the history of treatment for autism, because it demonstrated that (a) children with autism were capable of learning skills through systematic teaching efforts, and (b) intensive early intervention yielded significant improvements for a number of children with autism (Prizant & Wetherby, 1998). Central to the work of Lovaas was Discrete Trial Training (DTT), which is a "method for individualizing and simplifying instruction to enhance children's learning. For children with autism, DTT is especially useful for teaching new forms of behaviour (e.g., speech sounds or motor movements that the child previously could not make) and new discriminations (e.g., responding correctly to different requests). DTT can also be used to teach more advanced skills and manage disruptive behaviour" (Smith, 2001, p. 86). Teaching in this model consists of a series of "discrete trials," which are small units of instruction implemented by a BI who works one-to-one with the child in a distraction-free setting. Each discrete trial has five parts (adapted from Smith, 2001): 1. Cue (discriminative stimulus): The interventionist gives the child a brief, clear instruction, such as "Do this" or "What is it?" 2. Prompt: At the same time as the cue, or immediately after it, the interventionist assists the child in responding correctly to the cue (e.g., the interventionist may take the child's hand and guide him or her to perform the response, or the interventionist may model the response for the child). As the child learns the skill, the interventionist fades the prompt and ultimately eliminates it, so that the child learns to respond independently. 3. Response: The child gives a correct or incorrect answer to the interventionist's cue.  Experiences of Interventionists  1  4. Consequence:'If the child has given a correct response, the interventionist immediately reinforces the child with praise, hugs, tickles, small bites of food, access to toys, or other activities that the child finds rewarding/enjoyable. If the child gives an incorrect response, the interventionist responds in one of two ways: (a) Consequential Instructional Strategy: The interventionist says "No," looks away, removes the teaching materials and re-presents the cue again. (b) Antecedent (Errorless) Instructional Strategy: In errorless learning, there should be sufficient prompting provided to the child at the outset that the child is not ever given the opportunity to respond incorrectly. However, if the child does respond incorrectly, the interventionist would say nothing, clear the teaching materials away and re-present the cue again, this time providing a sufficient level of prompting that the child responds correctly. 5. Intertrial interval: After giving the consequence, the teacher pauses briefly (1.-5 seconds) before presenting the cue for the next trial. Children with ASD may receive up to several hours per day of DTT. Usually, a child in treatment will spend a few minutes at a time in DTT sessions, with one- to two-minute breaks in between, and a 10- to 15-minute break each hour (Smith, 2001). The intensity of the intervention varies, and there is much debate over how much intervention a child should receive (Smith, 2001). Up to 40 hours per week of one-to-one teaching has been recommended, particularly in the initial months of a child's program (Lovaas, 1996). Behaviour Interventionists  The people who work one-to-one with children with ASD in a DTT model of intervention are known by various titles, including behaviour interventionists, behaviour assistants, behaviour  Experiences of Interventionists  $  therapists, teachers, teaching assistants, and trainers. For the purposes of this study, this group of people will be referred to as behaviour interventionists (Bis). In general terms, a BI is defined as the person who carries out an ABA-based intervention under the guidance of a behaviour consultant or behaviour analyst (Scott, 1996). In a home-based ABA intervention, a team of Bis provides one-to-one intervention to a child with ASD in his or her family home (Lovaas, 1987). Bis are trained by experienced behaviour consultants to apply the principles of ABA to shape, reduce, and/or modify a child's behaviours. In addition, Bis are trained to teach the child a variety of skills in such areas as cognition, communication, social development, and self help (e.g., Leaf & McEachin, 1999). As described previously, these skills are taught in a highly structured teaching format, often in the form of discrete trials, although there may also be more natural, play-based teaching elements incorporated into the program (e.g., teaching a child how to take turns while playing a board game). Specific BI responsibilities typically include teaching curriculum in discrete trials, teaching appropriate play with toys, recording data, and reinforcing appropriate behaviour (Leaf & McEachin, 1999; Scott, 1996). There is no question that Bis play a central role in providing ABA-based intervention. They have been described as "the heart and soul of the behavior modification team" (Wilson, 1996, p. 18) and as "the people who do most of the work in intensive behavioral programs... their role is critical in the success of home-based behavioral, early intervention programs. They are, in a very real sense, the backbone of the program" (Scott, 1996, p. 231). Desirable attributes of quality Bis include patience, dependability, the ability to work independently, enthusiasm, and enjoyment of working with children with autism (Scott, 1996; Wilson, 1996). Clearly, Bis play an important role in helping the child with ASD achieve success and make progress. They are responsible for forming a positive emotional connection with the child, thereby establishing the  Experiences of Interventionists  9  foundation for teaching the child new skills and supporting him/her to make meaningful progress. Typically, Bis work intensively with children with ASD in the family home for a number of hours each week (Scott, 1996), and are therefore exposed to a host of unique, uncontrolled, and extraneous variables in their everyday work. Bis encounter a variety of daily challenges related to their experiences both with the child and his/her family. For example, a child's educational progress may be slow, or the child may exhibit resistance to engaging in social interaction (Maurice, 1993). A BI often works in isolation with a child for a number of hours each week, and may have limited contact with other team members while having extensive contact with the family (Kohler, 1999). Informal contact with the family is frequent because a BI works primarily in a child's home. Consequently, a BI may encounter challenges related to forming and maintaining an (oftentimes) intense, intimate, and complex relationship with the family. As Scott (1996) noted, "These strangers become a fixture in the home and privy to the most carefully guarded information about family strengths and weaknesses" (p. 231), and as a result, there is a "loss of privacy that accompanies home-based intervention" (p. 231). It should be noted that the current qualifications for Bis in Canada are very minimal, which is particularly surprising given the responsibility, intensity, and complexity of their jobs. In British Columbia, the only two requirements that people must meet to be employed as Bis are (a) be at least 19 years of age, and (b) have a clear criminal record check (http://www.autismbc.ca). There is no required level of education or training that people must have in order to be employed as Bis, nor is there a standardized training curriculum for Bis. Thus, it is the responsibility of each individual or employing organization to train Bis to provide one-to-one intervention to children with ASD. The job category of "BI" is also a relatively recent  Experiences of Interventionists \ 0  phenomenon. Many of the people who are employed as Bis are college or university students with educational and work backgrounds from a variety of fields that include education and psychology. Often, these people do not earn much more than minimum wage for their work as a BI. Stress and Coping of Bis At this time, no published research has examined the challenges and stressors experienced by Bis who work in families' homes. As noted previously, the job category of "BI" is a relatively recent phenomenon, which may explain why it is not well established in the body of literature on autism. When conducting a literature search for research and other materials specifically related to these individuals, a number of search terms were used, including behaviour assistants, (behaviour) therapists, (behaviour) interventionists, teachers, and 'j. educators. No published studies on this group of people were located. The literature search also involved manually searching volumes of journals that are directly related to the field of autism (e.g., Journal ofAutism and Developmental Disabilities) in an effort to find related research. Again, no articles were found that examined this particular group of service providers. However, Elfert (2002) conducted an unpublished qualitative study in which two women were interviewed about their experiences as Bis. One woman had worked as a BI with two families over a 2-year period, and the other woman had worked as a BI with four families over a 4-year period. Both of the Bis worked for one agency that provided ABA-based intervention in Canada. Each interviewee was asked to describe her work as a BI, including such issues as work-related challenges. A qualitative analysis of BI's responses indicated that there were many stressors involved in this kind of work and that the two Bis developed their own coping strategies to deal with the stressors.  Experiences of Interventionists  \ \  Stress. One of the stressors initially encountered by the Bis was working with the child with ASD. For example, in the initial stages of the job, one BI noted that she found it difficult to try and establish rapport with the child because he was frequently distressed and resistant to being engaged. As well, the child's family expressed a range of strong emotions (e.g., fear, desperation, hope) to the BI and had high expectations of her to help their child. Both of the Bis described feeling overwhelmed with the responsibility of educating children with ASD, and in particular felt pressure from the families to "cure" their children. Furthermore, both Bis felt unprepared for the emotional intensity and pressure of the work. Oftentimes, they felt alone and without adequate support and supervision from the agency for which they worked. These negative experiences culminated in feelings of tension, ambivalence, uncertainty, inadequacy, and lack of confidence in the Bis' ability to perform a challenging and stressful job. Furthermore, the stress and challenges integral to this intense work created feelings of "burn out" and (at times) a desire to simply quit. In addition to the stressors inherent in the work of these two Bis, Elfert (2002) found that maintaining professional boundaries when working closely with families was also stressful. Both Bis had worked for years with chronically stressed families and, in the process of bonding with and supporting them, felt both an obligation and a desire to continue working with them. The Bis reported that they developed relationships with the families that were both professional and personal. Work relationships with families gradually evolved into more personal alliances, as a result of working intensely with families in their personal living spaces for a number of hours each week. Interviewee A said, "I became very attached to this family and totally attached to the child, and I know they felt that I had the best connection with their child." Similarly, Interviewee B noted, "I got close to the family because things were happening." This closeness was  Experiences of Interventionists \ 2  experienced as being simultaneously uncomfortable and comfortable for both Bis, neither of whom worked for an agency that had established protocols for how to handle such situations. Working in families' private living spaces also meant that the Bis were inevitably exposed to private information about the family. Interviewee A commented that "I felt like I was invading their [the family's] privacy." Interviewee B noted that, "I listened and was told things I probably shouldn't be told." Both of the Bis struggled to maintain professional relationships with family members, but the daily exposure to families' private lives ultimately resulted in poorly defined boundaries and enmeshment in the families' experiences. Developing close emotional relationships also created some discomfort and awkwardness for the Bis, as well as a desire to lessen this intimate involvement. Interviewee B said, "I tried to keep distance, but it's very hard—[I didn't] want to isolate families who [didn't] have much support."- Interviewee A confided that "You don't want to get to know the family as well as you do, and you end up hating it." Parents of children with ASD are constantly involved in the stressful and consuming struggle of raising children with complex social, behavioural, and communication challenges. By virtue of their regular contact with the parents, the two Bis were also exposed to this ongoing stress. For example, Interviewee B commented that "[the] family was under a lot of stress.. .1 always felt that everyday when I went to their home, and it wasn't the most pleasant experience." Furthermore, parents were perceived as relying upon the Bis to not only provide their children with educational support, but to also provide them with emotional and psychological support. Interviewee A admitted, "[I] felt like a crutch for the family — they became dependent on me." In time, both of the Bis came to value the family's need and reliance upon them, although they also experienced feelings of discomfort and even resentment as a result of this powerful emotional  Experiences of Interventionists 13  attachment. Wasik and Bryant (2001) have noted that "sometimes the boundaries that define the home visitor-client relationship become blurred. The professional relationship between two individuals can begin to look and feel like a personal friendship.. . . A balance needs to be struck between genuine professional concern and maintaining appropriate professional boundaries" (p.. 214). Furthermore, they acknowledged that this balance "is difficult to define and more difficult to achieve" (p. 163). Similarly, Lovaas noted that "Close emotional relationships [between Bis and parents] may too easily interfere with competent treatment" (1996, p. 246). Coping strategies. In order to deal with the stressors and pressures of working with a child in a family's home, the two Bis developed their own coping strategies and coping resources (Elfert, 2002). One method was to share experiences with family, friends, and coworkers. Interviewee A said that "It was so important to have a support network," and that in confiding in other team members, "[it] felt better to find out that I wasn't alone in how I felt." Disclosure to trusted people provided this BI with much-needed validation and emotional support. Both interviewees also revealed that avoiding or denying their stressful experiences by focussing on more positive work experiences was helpful. For example, Interviewee A said, "I learned to ignore and block out 'crap.'" Interviewee B admitted that "[another] home I worked in offbalanced the [stressful] home." Regular exercise was also deemed to be helpful for alleviating the tension. Finally, Interviewee A described communicating with other team members in daily logs as therapeutic—"It [writing in the log] helped me get it out." Interestingly, another way that the Bis appeared to cope with the emotional intensity of the work was by learning to distance themselves from subsequent families. In their relationships with later families, both Bis revealed that they had learned to develop a more professional demeanor and worked hard to establish clearer psychological and work boundaries. Shared  Experiences of Interventionists \ 4  experiences with subsequent families were largely limited to work-related issues, thereby reducing the level of personal involvement and time spent with the families. For example, Interviewee A revealed that later relationships with families were "more professional, and I kept more of a distance... [I was] just basically there for  3 hour session and then I'd leave.. .you  don't have that connection with them, you know... Y o u want to help them but it's not the same." She defined being professional as "not sharing my personal life with the family." Furthermore, "I did what was necessary and what was required of me and that was all." Both B i s indicated that trying to maintain more well-defined work boundaries with-families resulted in less emotional attachment to the families and less enmeshment in the families' issues. Clearly, providing intervention to children with A S D in their homes produces a complex and intense situation, whereby many variables and dynamics interact to create a challenging role both for the B i s and the families they support. Furthermore, the actual work place presentsits own unique and significant challenges, as Bis are working in family living spaces. Thus, Bis are often privy to intimate information about the family, because they work and interact with family members in their private and personal environment (Scott, 1996). Although B i s are typically trained by behaviour consultants to work with the child and are reportedly "taught to behave in a professional manner with parents" (Lovaas, 1996, p. 246), they usually do not receive formal training or support in how to deal with the intense psychological experiences continually present in their line of work. Furthermore, they are usually not provided with or taught appropriate coping strategies to help ameliorate their occupational stress.  Research on Home Visiting With the exception of the unpublished work by Elfert  (2002), no research appears to exist  on the experiences of Bis. However, researchers have examined the complex role of people in  Experiences of Interventionists \ 5  other helping professions who work in family homes. At this time, the most similar literature base is related to "home visiting," which was defined by Wasik and Bryant (2001) as "the process by which a professional or paraprofessional provides help to a family in their, own home" (p. 1). Much of the research on home visiting has been conducted on nurses who visit families in their homes, often referred to in North America as community nurses or district nurses, and in Great Britain as health visitors. Other home visiting occupations include early childhood special educators and infant development specialists who work in family homes with young children with disabilities. For the sake of clarity, the broad group of people who provide services to families in their homes will be referred to in this section as home visitors (HVs). However, when a particular research study was conducted with a specific sub-group of HVs (e.g., health visitors, community health nurses, etc.), participants will be referred to by the specific titles used in the study. Researchers in the field of home visiting have identified various stressors associated with performing this kind of work, such as the potential for emotional over-involvement with clients, excessive or irregular work hours, and lack of support services (e.g., Greenberg, 1980). Wasik and Bryant (2001) noted that "home visiting can have many rewards associated with seeing families grow and develop. Yet it is a front-line, stressful position that can be lonely and at times frustrating. Visitors generally work alone and away from coworkers during a normal day and thus do not have frequent contact with peers. The work itself can be physically tiring and emotionally draining because families face many of life's most pressing problems" (p. 98). In their work, HVs are often exposed to many powerful and oftentimes negative emotions (e.g., grief, feelings of failure) experienced by family members (Greenberg, 1980), and find themselves in a unique position to help the family process and deal with these feelings.  Experiences of Interventionists \ 6  Greenberg noted that "in dealing with people, [HVs] have far greater personal interaction and more in-depth knowledge of their clients' personal values and attitudes than do most other workers" (p. 6). In some cases, this intense and intimate relationship may add other dimensions to HVs' roles—for example, they may become involved i counselling their clients. Indeed, in some early articles addressing the roles and responsibilities of health visitors in Britain, counselling is deemed to be an appropriate and necessary part of the job (Ballard, 1982; Burnard, 1987; Russell, 1981). This issue will be discussed in greater detail in a subsequent section. Regardless of the specific roles filled by HVs, providing services to families in their homes is multifaceted and challenging work. In the section that follows, the empirical literature on stress for HVs will beexamined. This area of research is relevant and appropriate to the present study because the work-related issues encountered by Bis most closely resemble the issues encountered by HVs in general. Of particular relevance is the fact that the work environment of both HVs and Bis is the same (i.e., family homes). Research on Stress in Home Visiting  Some of the earliest articles on home visiting are not empirical in nature, but nonetheless provide important information about the process of delineating the roles and responsibilities of HVs. For example, an article by Russell (1981) discussed the health visitor's role in England and addressed the issue of whether health visitors should counsel the families they support. Russell argued that professionals who care for individuals with disabilities and their families at home need "sufficient counselling skills to be able to respond sensitively to the emotional and psychological needs of the family" (p. 473). Furthermore, Russell acknowledged that the "role of the health visitor in supporting the family with the handicapped child is a crucial one and still  Experiences of Interventionists \ 1  evolving" and that "the new partnership with parents is a challenging one. There are many delicate areas, such as the boundaries between professional objectivity and subjective friendship" (p. 475). Thus, we see that the issues of developing professional boundaries and providing emotional support to families are very much longstanding ones for health visitors who support families and provide services to them in their homes. Similar articles have discussed the "role dilemma" of health visiting, and have questioned the responsibilities and function of this group (e.g., Robinson, 1983). An article by Ballard (1982) also addressed the issue of health visitor as counsellor. He wrote, "I would like to suggest that health visitors have an important role to play in helping with the complex psychological and social problems which beset a small number of the individuals and families with whom they deal from day to day" (p. 531). He acknowledged that health visitors may be performing duties that they have not been professionally trained to perform, but argued that "counselling is about gradually building up an awareness of the kinds of issues I have described and gently introducing them into one's repertoire of human relationship skills" (p. 532). Furthermore, Ballard suggested that counselling "is an attempt to build a relationship which is challenging in that it demands that people in difficulty should face up to what is going on in ways which are realistic and honest and having reached that point, to move on and do something about it" (p. 532). Again, the process of building relationships with families is emphasized. HVs, by developing consistent contact and close relationships with families through home visits, are perceived as the appropriate professionals to provide some form of counselling. An early commentary by Goodwin (1983) discussed specific sources of stress that health visitors may face when working in family homes. The list of potential stressors included (a) limited resources (e.g., crowded office space, shortage of social services); (b) management  Experiences of Interventionists \ 8  constraints (e.g., rigid procedures, programs that are difficult to implement); and (c) role ambiguity (e.g., uncertainty about role, clients making requests of health visitors that cannot be met). Another purported source of stress was the pressure on health hisitors to meet clients' needs. In this regard, Goodwin wrote, "supporting people in distress, in the hope that this support will help them through the crisis and strengthen their coping abilities for the future, is surely what the job is all about. But there can be little doubt that being involved at this level is more stressful than keeping a low profile in client relationships" (p. 20). Again, there is the recognition that working closely with, and supporting families can create stress for HVs. Moreover, like previous authors, Goodwin discussed the challenge of maintaining professional boundaries: "It sometimes can be difficult to combine a professional approach with the warmth and openness that makes health visitors approachable, and keeping the right balance between the two may be stressful, particularly for inexperienced health visitors" (p. 21). This acknowledgement—that maintaining a balance between professional boundaries and genuine concern for families is challenging and difficult to achieve—was strongly reiterated by Wasik and Bryant (2001) almost 20 years later. In terms of empirical research, there have been various studies conducted on the stress associated with home visiting, including investigations of specific sources of work stress. One of the earliest studies was an exploratory survey inquiring about job stressors experienced by health visitors working in family homes in Great Britain (Bennett & Dauncey, 1986). Health visitors were asked to recall two worrying incidents since the beginning of their supervised practice and to give reasons for their feelings associated with these events. The results indicated that 44% of respondents named abused or possibly abused clients as their most worrying incident, and identified feelings of failure or inability to deal with the given situation as a result. The findings'  Experiences of Interventionists \ 9  were similar to those reported by Appleby (1987), who examined sources of stress in health visitors in their first year of practice in Great Britain. A total of 18 health visitors filled out a questionnaire asking them to rate how stressful they perceived 27 different aspects of their work. The top-ranked source of stress named by participants was coping with actual arid suspected cases of child abuse and neglect. Other stressors included (a) trying to help families with seemingly intractable problems, (b) lack of resources, (c) extra workload due to staff shortages, (d) lack of training, and (e) uncertainty regarding their professional roles. Davison (1987) conducted a pilot study that examined occupational stress in health visitors working in family homes. A total of 37 health visitors working in an inner city area of England participated. A 21-item questionnaire was developed for the purposes of the study that asked participants to rate their work experiences on a 7-point scale ranging from "never" to "always." Higher scores were purported to indicate higher levels of stress—for example, scores greater than 4 were deemed to be indicative of "burnout," whereas scores between 2 and 3 were considered indicative of acceptable stress levels. The results showed that the mean overall score was 3.3. The largest group of participants (n - 7) scored within the burnout range, and the second largest groups (n = 5 in each) scored between 3.5 and 3.9 and between 2.5 and 2.9. No clear relationship between length of service and stress was found.  '  '  West, Jones, and Savage (1988) conducted a two-part study in Britain that examined occupational stress in health visitors working in family homes. For the quantitative portion of the study, a total of 145 health visitors from two neighbouring health authorities in Britain participated. Participants completed the General Health Questionnaire (GHQ), a standardized measure that is used to detect psychological strain and provide a picture of a person's general health. The results indicated that health visitors had significantly higher GHQ scores than  Experiences of Interventionists 20  comparison groups of female engineering plant employees and second year psychology undergraduates approaching year-end exams. However, the health visitors' GHQ scores did not differ from comparison groups of medical students and student nurses. In add ion, 44% of health visitors scored 3 or above on GHQ items, indicating significant emotional distress. This was higher than the scores of comparison groups of both unemployed people and medical students. Furthermore, 34% of health visitors scored at 4 or above on GHQ items, compared to only 9% of unemployed people and 30% of medical students. Five health visitors reported "alarmingly high" scores of 10 or above on GHQ items. The authors concluded that "health visitors are a working group experiencing significant stress.. .Many are working under a level of pressure likely to render them significantly less effective in the performance of their duties, quite apart from the personal cost to them in emotional, psychological and physiological terms" (p. 61). For the second part of the study, West and Savage (1988) compiled qualitative information about the experience of work-related stress in a sample of health visitors. A total of 92 health visitors working in the Dovetown Health Authority in Britain participated. Participants were asked to describe the three major stressors in their work and provide an account of the most stressful event in working life in the past 30 days. In addition, participants were asked to record on a daily basis the most troublesome event/issue of the day for a period of 15 working days. The results found that the three most significant work-related stressors were (a) work pressures (e.g., lack of time, work overload, clerical pressures); (b) difficult cases and visits; and (c) emotional issues (e.g., feelings of inadequacy, helplessness, isolation, low motivation, low self esteem, guilt). These three sources of stress accounted for 56% of stressors described by participants. The most stressful work events that had occurred in the last 30 days included (a) handling difficult cases (with a parent or family focus), (b) work overload, (c) visiting homes in actual or potential  Experiences of Interventionists 21  infant death cases, and (d) difficulties in dealing with other coworkers/ colleagues. These four categories (out of eleven total categories) accounted for 51% of the stressful events described. The top four categories of stressful events recorded in diaries in a period of 15 working days were (a) handling difficult cases (e.g., hostile clients, children at risk); (b) intrinsic work difficulties (e.g., no access visits, case conferences, court cases); (c) administrative difficulties, and (d) professional relationships. Fletcher, Jones, and McGregor-Cheers (1991) examined the relation between occupational stress and demands, supports, constraints, and psychological health in health visitors working in family homes. A total of 70 female health visitors working in England participated. Participants filled out a number of questionnaires developed for the study, including one on work supports/constraints. Overall, the results showed that health visitors were satisfied with their jobs and that health visiting was only a moderately stressful occupation. The greatest perceived job demands related to working with difficult families, in addition to frustration within the job, inadequate community resources, and the amount of clerical work and paperwork. Other sources of stressors included the health visitors' changing roles, and the emotional effects of the job. Overall, demand scores were negatively correlated with job satisfaction. Various kinds of client contacts were demanding but were not found to be associated with poor psychological health. Stewart and Arklie (1994) conducted a correlational study to examine the relations among stress, support, and satisfaction in Canadian community health nurses (CHNs) working in family homes. A sample of 101 female nurses working for the Nova Scotia Department of Health and Fitness participated in the study. Participants filled out the Nursing Stress Scale, a 34-item self-report survey that assesses various aspects of work-related stress. The three main sources of  Experiences  of Interventionists  22  stress for CHNs were (a) insufficient time for client care, (b) poor work environment, and (c) difficult clients. Other stressors included unclear role definitions and conflict with other service providers. Not surprisingly, stress was negatively related to job satisfaction. Moore and Katz (1996) surveyed home health care nurses working in family homes about their perceptions of work-related stress. Sixty-seven nurses working in Midwestern USA filled out the Nursing Stress Scale. The highest stressor for the home health nurses was "Not enough time to complete all of my case manager activities and paper work." The second highest stressor was "Documentation to meet reimbursement guidelines." The third highest stressor for home health nurses was "Not enough information from a physician regarding the medical condition of a patient." There was no significant difference in stress levels between home health care nurses and a comparison group of acute care nurses working in hospitals. Overall, the results showed that the highest levels of stress experienced by home health nurses were related to administration and paperwork. McBride and Peterson (1997) conducted a study to examine the content and process of home visits conducted by Early Childhood Special Educators (ECSEs) in the United States. Fifteen ECSEs working in Iowa participated in the study. In addition to observations and specific data collection, the researchers interviewed the ECSEs about barriers to providing services to families and children. Twenty-seven percent of the participants identified insufficient training as problematic, and 47% cited characteristics of families or difficulties in the family-professional relationship as a barrier to service delivery. Unfortunately, no details were provided about what the actual frustrations were with regard to family-professional relationships, but the fact that almost half of the respondents cited this area as problematic is significant. McBride and Peterson concluded that "both families and the processes of intervention are extremely complex. Given  Experiences of Interventionists  23  this, as well as interventionists' expressed frustrations and need for additional training, clinical supervision and support for home interventionists on an ongoing basis are clearly needed" (p. 203). Snelgrove (1998) studied the self-reported stress levels of community health practitioners working in the UK. The group of participants was comprised of 68 health visitors, 56 district nurses, and 19 community psychiatric nurses for a total of 143 participants. All three groups of nurses cared for various kinds of patients in the patients' homes. Participants filled out the General Health Questionnaire (GHQ) and a 47-item questionnaire designed for the purposes of this study that identified sources of work-related stress. The levels of reported work stress were examined in relation to occupational specialty. Significantly different levels of stress were experienced by each of the three groups, with health visitors reporting the highest level of stress. Although their stress scores were lower than those of the health visitors, district nurses also reported significantly high levels of stress in comparison to normative populations. The sources of workplace stress correlated significantly and positively with GHQ scores. A factor analysis revealed four distinct sources of stress that accounted for 38% of the variance: (a) emotional pressure/difficult cases, (b) unpredictable events at work, (c) change and instability at work, and (d) work content. Snelgrove postulated that health visitors' higher stress scores might have been due to the composition of their caseloads, because these professionals were responsible "for the health profiles of all the children under five years of age in their care. It is well documented that child care is a particularly stressful area of work" (p. 102). He argued that his data supported this conclusion because some of the key work stressors identified were related to problems with childcare, poor social conditions, and family problems.  Experiences of Interventionists 24  Rout (2000) investigated sources of stress among district nurses in northwest England. A total of 79 female nurses participated in the study, ranging in ages from 25 to 64 years. Nurses completed a variety of measures, including three subscales of the Crown-Crisp Experiential Index, which measures mental well being, and a job stress questionnaire which measures sources of work-related stress. A factor analysis of the stress questionnaire responses identified five significant stress factors that accounted for 50% of the variance: (a) demands of the job and lack of communication (e.g., dealing with problem patients, increased demands from patients); (b) working environment (e.g., being undervalued, taking work home); (c) career development (e.g., little opportunity for career development); (d) problems with patients (e.g., having to work unusual hours, language problems with patients); and (e) work/home interface and social life (e.g., having too much work to do, demands of the job on social life). The first three of the  five  stressors were predictive of high levels of job dissatisfaction. Interestingly, one job stressor was predictive of job satisfaction: problems with patients. Summary  of Stress in Home  Visiting  Overall, most of the studies reported that HVs experienced significant levels of workrelated stress. The study by Fletcher et al. (1991) was the one exception, where health visiting was found to be "moderately stressful." Furthermore, the results indicated that there were many similarities in the kinds of issues reported to be stressful. The most frequently cited issues related to work pressures such as (a) workload and time constraints; (b) difficult clients and home visits; and (c) emotional issues such as feelings of isolation, inadequacy, and helplessness. Other factors that created stress for HVs were (a) role ambiguity or unclear role definitions; (b) lack of training; (c) lack of communication between team members; (d) change or instability at work; and (e) problems with coworkers/ colleagues.  Experiences of Interventionists 25  Criticisms of Research on Stress in Home Visiting  The research on stress in home visiting suffers from two primary methodological weaknesses, which will be outlined below. The first problem pertains to how stress was conceptualized and operationalized in these studies. Definition and conceptualization of stress as a phenomenon. In the literature on the work  stress experienced by HVs, stress was rarely operationally defined. Most authors failed to give a clear definition of stress and apparently assumed that the term "stress" was universally understood as a common phenomenon. For example, participants in a number of studies were asked to rate their level of stress on a Likert scale, but no definitions of stress were provided to frame their responses (Appleby, 1987; Fletcher, Jones, & McGregor-Cheers, 1991; Rout, 2000). Thus, there might have been unaccounted-for variability in participants' stress ratings because they might have framed their responses using their own (variable) definitions. One exception to this was the qualitative study conducted by West and Savage (1988), where the goal was to have participants describe in their own words what was stressful to them about their work. In this qualitative research, the objective was not to narrowly operationalize stress. Rather, by using an open-ended approach, the authors allowed for a broad examination of work stressors as described by the participants who experienced-it. A second issue concerns the lack of a theoretical foundation or basis for the research. In almost every study reviewed previously, no theoretical model or framework was provided to account for stress in a particular occupation. Almost all of the researchers failed to address the "big picture" with regard to research results by explaining how stress was conceptualized and how they believed it functioned in their participant populations. The one study that did attempt to provide a more comprehensive conceptualization of stress used the Demands, Supports, and  Experiences of Interventionists 26  Constraints' model as a framework to examine the relationship between these three variables (Fletcher et. al, 1991). The model considers the degree of occupational strain to be the result of the balance among job demands, job supports, and job constraints. The model predicts that increased support will lead to a reduction in strain, even when demands are maintained at a constant level. Overall, although numerous theories of occupational stress abound in the literature, few theories have guided the empirical examination of stress in the human service professions. Thus, many studies in this area are lacking conceptual models to account for occupational stress, which ultimately weakens their overall empirical contributions. As Guglielmi and Tatrow (1998) pointed out in their integrative review on occupational stress in teachers, it is fruitful to utilize existing theories of stress and apply themto'particular populations. Using a theoretical framework helps to determine the selection and operationalization of constructs, thereby producing greater measurement consistency. A theoretical model also guides the choice of appropriate research questions and helps to organize research findings. Future research of stress in HVs should endeavour to utilize one of the existing conceptual models of occupational stress, to guide both the choice of measurement techniques "and the analysis of results. The use of non-standardized instruments. A second concern with the HV stress research is that, although some authors did use standardized measures, the majority developed questionnaires and surveys for the purposes of their particular study. As a result, the measures lacked information regarding their psychometric properties, such as validity and reliability. The study by Davison (1987) exemplifies some of the methodological problems that resulted from this approach. Participants were given a 21-item questionnaire and asked to rate their work experiences on a 7-point scale ranging from "never" to "always." Higher scores were indicative  Experiences of Interventionists 27  of higher levels of perceived stress. However, the questionnaire lacked data concerning reliability and validity, and it was not clear what construct was actually being measured. Only two sample questions were provided (e.g., "How often have you felt worthless?" and "How often have you felt rejected?"), and it was unclear how these questions assessed work-related stress in health visitors. Furthermore, the author used cutoff points to represent the different levels of stress (e.g., scores greater than 4 were said to be indicative of "burnout," whereas scores between 2 and 3 were said to be indicative of "acceptable" levels of stress), but there was no empirical evidence provided to support these seemingly arbitrary classifications. Although this was a particularly flawed piece of research, similar issues plagued a number of other studies. For . example, most studies used Likert scale questionnaires to assess the variables of stress and work environment, but it was not determined whether the scale intervals were equal and reliable. Clearly, future research on HV stress should employ instrumentation that is standardized as much as possible, so that the results can be interpreted accurately and meaningfully. Research on Coping Resources in Home Visiting  In addition to the literature on the stress associated with home visiting, there is also research on the coping and support strategies used by this group of people. This area of research is less developed than the literature on stress in home visiting, because fewer studies have been conducted on the coping strategies of HVs. One of the earliest studies investigated the functions of professional support and support groups for health visitors in England (Appleby, 1987). A semi-structured interview was administered to five nurse managers and six support group leaders. "Professional support" was defined by interviewees as opportunities that allowed them to share experiences, reduce feelings of insecurity, increase confidence and self-esteem, develop and enhance professionalism, and grow and continue to learn. Both managers and support group  Experiences of Interventionists 28  leaders noted that professional support originated from three sources—peer groups, managers, and support groups—with each group serving a slightly different function. Peer group support was described as "day-to-day" support offered in the work situation and was acknowledged as a "powerful protection against 'burnout'" (p. 77). Management support was viewed as being largely concerned with caseload management, organizational issues, and standards of practice. Support groups were described as dealing with issues such as (a) client problems and associated emotions/feelings, (b) interpersonal problems with colleagues, and (c) anxieties about aspects of the job (e.g., uncertainty about one's role). The author concluded that each type of support offered something different to health visitors: "The implication is that, in very broad terms, day to day support and encouragement comes from the peer group, guidance regarding the practicalities of caseload management comes from the managers, and help with personal feelings comes from support groups" (p. 77). The second part of the Appleby (1987) study elaborated on the functions of support groups, through interviews with managers and support group leaders as well as through administration of a questionnaire to 12 health visitors. The results indicated that support groups helped participants (a) develop and enhance their professional knowledge and expertise in handling clinical situations; (b) develop greater insight into human interactions, thus enabling more effective handling of situations; (c) share feelings about stressful aspects of the job, in order to gain emotional and practical advice about how to cope; and (d) experience an atmosphere of containment, within which resources could be mobilized. Furthermore, support groups were seen as helping health visitors deal with problems more efficiently, thereby wasting less time; and successfully manage difficult work relationships, thereby leading to improved collaboration and service delivery. Finally, all respondents agreed that support groups were seen  Experiences of Interventionists 29  as effective in reducing their work-related stress. Appleby concluded that "given the potential scope of health visiting and the social context in which it is practiced today, a certain amount of stress is inevitable. Whilst the long term aims should be to reduce those factors which create stress, health visitors need to be helped to deal with day-to-day stress (p. 78)." Furthermore, she noted that "support groups can plan a significant part, not only in reducing stress, but also in enhancing professional development, as well as job satisfaction" (p. 78). The supervisors of health visitors who were interviewed indicated that "support should be provided for all health visitors, since working in an area of caring is very demanding and staff at all levels need support in order to help them cope better, ultimately in order to work more effectively with their clients" (p. 77). A related study by West and Savage (1988) examined the sources of support and coping mechanisms used by 60 health visitors working in family homes. Health visitors completed both a questionnaire about sources of support and a working diary in which they were asked to indicate who they had talked to about each stressful work event they had experienced over the past 15 days. For the questionnaire, health visitors were asked to indicate how they had dealt with stressful events in one or more of eight ways. The four main methods of coping with stressors were: (a) thinking about solutions to a problem, gathering information about it, or actually doing something to try and solve it; (b) accepting that the problem had occurred, but that nothing could be done about it; (c) diverting attention away from the problem by thinking about other things or engaging in some activity; and (d) seeking or finding emotional support from loved ones, colleagues, friends, or professionals. In terms of sources of support, health visitors indicated that they primarily relied on colleagues to help them deal with work-related stressors and crises. Husbands/partners ranked second in providing social, emotional, and practical  Experiences of Interventionists 30  support. Other relatives and friends were ranked third; and finally, senior nurses were ranked fourth. However, the results from the working diaries indicated that, when actually discussing stressful work incidents with others, the health visitors relied almost exclusively on colleagues, suggesting that "health visitors over-rate the extent to which they turn to their partners for immediate support in dealing with work problems" (p. 367). Clearly, these health visitors found their work colleagues most useful in helping them deal with work-related stressors. A study by Fletcher et al. (1991) also investigated the work-related supports and coping strategies used by health visitors working in England. Seventy health visitors filled out a questionnaire on work supports and a measure of coping processes. The results found that the most important type of support (in terms of highest mean score) was support and encouragement from colleagues; 87% of health visitors thought that this made the job easier most or all of the • time. Seventy-nine percent of respondents indicated that the autonomy and variety of the work made the job easier. Seventy-six percent felt that the interest and variety of their work made the job easier, and 79% felt that the professional competence of colleagues made the job easier. Other supportive features included (a) performance feedback from colleagues, (b) opportunities to talk to colleagues during lunch hour and breaks, (c) the intellectual challenge of the work, (d) support from spouses and family members, (e) training and education, and (f) the knowledge that health visiting was an important area of service provision. The three coping strategies that were rated as most useful by these health visitors were (a) direct action (used by 96% and rated as very useful by 83%); (b) social support (used by 91% and rated as very useful by 51%); and (c) good social skills such as negotiation, humour, and good communication (used by. 86% and rated as very useful by 36%). Least used and least useful were relaxation activities and distraction (i.e., trying not to think about the problem/issue). Similar to the results reported by West and Savage  Experiences of Interventionists 31  (1987), this study indicated that direct action was the most used method of coping. However, West and Savage found that acceptance and diverting attention away from problem was used more often that social support, whereas Fletcher et al. found that social support was commonly used and distraction was not used. A study by Stewart and Arklie (1994) examined the types and sources of support experienced by Canadian Community Health Nurses (CHNs) working in family homes. One hundred and one CHNs completed the Norbeck Social Support Questionnaire. The three major sources of support identified by CHNs were family, friends, and work associates. Family members (including spouses) provided 43% of the functional support; friends provided 28%, and work associates provided 24% of functional support. The primary types of support received were emotional and affirmational. Interestingly, perceived lack of support from supervisors was a source of stress frequently identified by the CHNs in this report. Moore and Katz (1996) conducted research on the social intimacy (i.e., support) experienced by home healthcare nurses in the Midwestern part of the United States. Sixty-seven home healthcare nurses completed the Social Intimacy Scale, which consisted of 15 Likert scale items. The researchers defined social intimacy as "the sharing of an individual's appraisal of stress, the unloading of troublesome thoughts, and the opportunity to clarify subjective reality without being guarded" (p. 966). Although not much detail was provided about the social intimacy results, the authors did report a significant positive correlation between self-esteem and social intimacy/Interestingly, it was also found that single, divorced, and separated nurses scored higher than married nurses did on social intimacy. Moore and Katz suggested that—perhaps— single, divorced, and separated nurses shared their experiences with others to reduce workrelated stress, whereas married nurses did not. They also suggested the possibility that married  Experiences of Interventionists 32  nurses may have used other coping mechanisms (e.g., avoidance). However, they concluded that "all nurses need support group interventions to reduce job-related stress" (p. 968). Finally, Rout (2000) conducted a study that, among other things, examined the coping strategies used by a sample of 79 district nurses working in England. Rout used a shortened version of the Ways of Coping Checklist, which asked participants to recall a recent stressful event at work and indicate on a 12-item inventory how frequently they used specific strategies to help them cope. The nurses reported that their most popular coping strategy was talking to someone about their feelings, followed,by concentrating on what had to be done next and, finally, talking to someone who could do something about the problem. The least popular methods were (a) avoiding being with people, (b) continuing on as though nothing had happened, and (c) self-blaming. Summary of Research on Coping in Home Visiting  The research on coping resources and coping strategies in HVs is varied, and includes research on types of support, issues requiring support, and coping strategies. The three most common groups of people reported to provide support to HVs were partners and family members, friends, and work associates. In general, support was deemed to be helpful in dealing with issues related to (a) administration (e.g., caseload, scheduling, paperwork); (b) difficult clientele (e.g., abused children, hostile parents); (c) job performance (e.g., uncertainty about one's capabilities to do the job); and (d) the negative emotions or feelings borne out of these issues. The most common coping strategies listed in the research were (a) problem solving/direct action (e.g., determining what could be done to resolve the issue); (b) resignation (e.g., accepting that nothing could be done about a problem); (c) avoidance (e.g., denying the problem and  Experiences of Interventionists 3 3  continuing on as though nothing had happened); and (d) seeking emotional/social support from family, friends, and work colleagues. Criticisms of Research on Coping in Home Visiting  The research on coping in home visiting suffers from the same methodological weaknesses found in the research on stress in home visiting. The first issue concerns the operationalization of coping. In the majority of the studies, the authors failed to provide an operational definition of coping. Thus, it was unclear how respondents conceptualized this construct as they completed the surveys or other tools that were used to measure coping. Secondly, most of the studies did not provide a theoretical foundation for the research being conducted. Thus, there was no theoretical model or framework that accounted for coping strategies in HVs. Finally, as was the case with the majority of HV stress research, many of the studies used non-standardized measures that were developed for use in a particular study, and thus lacked adequate psychometric information regarding validity and reliability. Theories of Stress and Coping  Now that the research on home visiting has been summarized, it is important to briefly review some of the major theories related to stress and coping and how they apply to this area of research. There is an abundance of literature on theories of occupational stress, as well as information on coping strategies and resources. Person-Environment Fit theory. One of the most well-known theories of occupational stress is the Person-Environment Fit (P-E Fit) theory, which postulates that stress and strain in work settings are attributed to the interaction of an individual with his/her work environment (French, Caplan, & Harrison, 1982). Occupational stress is thought to result from a poor personenvironment fit (i.e., subjective-objective fit), producing psychological and physiological strain.  Experiences of Interventionists 34  Thus, occupational stress is defined as the degree of misfit between a person and his/her environment. Demand-Control model. The Demand-Control model (Karasek, 1979) also focuses on the interaction between the individual and his/her work environment. Specifically, the focus in this model is on the interaction between the objective demands or pressures of a work environment and the decision-making ability of a worker in fulfilling his job requirements. The combination of high demand with little control is believed to contribute to psychological strain. Thus, high strain jobs are those where the individual has a lot of responsibility but little control over how things are done. Transactional Process model. The P-E fit and Demand-Control theories focus on the general demands of a specific job and on the skills and abilities of a worker. However, Lazarus (1981) believed that it is important to also take into account specific job pressures as well as individual differences in workers' personalities and coping resources. In his Transactional Process model (Lazarus, 1981), occupational stress is conceptualized as a transaction between an individual and his/her work environment, and is seen as a combination of environmental demands and individual resources. Stressful antecedent conditions (stressors) are cognitively appraised by a person as threats, and are influenced by the individual's coping resources. Emotional reactions are evoked when a stressor is perceived as a threat and the person does not have the coping resources needed to deal effectively with it. Thus, the person's cognitive appraisal of stress depends on both the extent of an environmental demand and his/her resources available to cope with the demand. Stress, Strain, and Coping model. Osipow and Spokane (1984) developed a model similar to that of Lazarus (1981) that they did not officially name, but that will be referred to here as the  Experiences of Interventionists 35  Stress, Strain and Coping (SSC) model. The SSC model consists of a system in which occupational stress, strain, and coping resources interact. Occupational stress is seen as having significant consequences—namely psychological strain—which can affect the individual's work performance. That is, psychological strain is the negative outcome of work stress. However, the SSC model predicts that "where perceived occupational stressors are equal for two people, differences in coping resources would serve to moderate the resulting strain" (Osipow & Davis, 1988, p. 2). Thus, high occupational stress does not by itself result in psychological strain; rather, an individual's coping resources must be accounted for in order to predict the degree of strain experienced. Although the objective aspects of occupational stress are thought to be significant, it is the individual's "perceptual filter that operates in a crucial fashion with respect to whether a given experience is construed to be stressful" (1988, p. 2). Thus, coping skills are critical to this model because they mitigate the individual's experience of stress. The SCC model is based on a "social roles model of occupational stress" (Osipow & Spokane, 1984, p. 71) and makes two assumptions: (a) peoples' perceptions of the social roles assigned to them in the workplace is of critical importance, even moreso than any "objective" reality; and (b) social roles interact with peoples' capacity to cope with negative occurrences in a way that can reduce strain. In this model, occupational stress is associated with performing specific stress-inducing work roles, of which there are six: (a) role overload, (b) role insufficiency, (c) role ambiguity, (d) role boundary, (e) responsibility, and (f) physical environment. Thus, the work context is an important dimension of this model, because the work roles performed by an individual are directly related to his/her level of occupational stress. These six work roles will be described in greater detail in Chapter 2.  Experiences of Interventionists 36  Osipow and Spokane's model draws upon various earlier theories of occupational stress to explain how stress, strain, and coping interact within the SSC framework. For example, in the major theories of occupational stress, one common assumption has been that work-related stress creates significant strain for the individual, which in turn effects work performance. Osipow wrote, "this distinction between perceived stress and experienced strain was seen as being critical to any successful model of occupational stress" (1998, p. 21). However, the SCC model is more well-developed than earlier models of occupational stress. In addition to differentiating between occupational stress and psychological strain, the model accounts for individual differences in personality and perception, which some of the earlier models do not. In the SCC model, occupational stress does not simply equalpsychological strain; rather, the individual's level of experienced strain is determined by his/her level of coping resources. Therefore, different people experience stress in the same occupation differently. This is an important element that makes the SCC model more interactive than previous theories, with the exception of Lazarus (1981). Present Study  As demonstrated in the review of stress and coping research related to home visiting, as well as the results of the exploratory study by Elfert (2002), working in families' homes can be stressful and challenging for Bis (and HVs). The foremost objective of the present study was to collect empirical information about the stressors experienced by, and the coping resources utilized by Bis, because no published research has examined this group of service providers. The study attempted to answer the following questions:  Question #1:  What specific work roles, as measured by the ORQ of the OSI-R (Osipow, 1998),  are rated by Bis as being most stressful?  Experiences of Interventionists 3 7  Question #2: What is the nature of the relation of Bis' occupational stress, as measured by the ORQ of the OSI-R, to the 10 subscale scores on the FES that describe specific characteristics of the "challenging" families with whom they work?  Question #3: What is the nature of the relation of Bis' occupational stress, as measured by the ORQ of the OSI-R, to the five subscale scores on the ABC that describe behavioural characteristics of a child with autism?  Question #4: What is the relation among stress (measured by the ORQ of the OSI-R), strain (measured by the PSQ of the OSI-R), and coping (measured by the PRQ of the OSI-R)?  Question #5: What do Bis perceive to be the most and least enjoyable aspects of their work?  Question #6: What additional training and support do Bis believe they need to be more competent, skilled, and successful in their work?  Experiences of Interventionists 3 8  CHAPTER 2 Method Participants  The following criteria were used to recruit potential behaviour interventionist (BI) participants: (a) they provided 1:1 intervention to one or more children with autism in family homes, (b) they had at least six months experience as Bis, and (c) they currently worked for one of the six organizations whose Directors agreed to distribute recruitment letters. The participating organizations were located in Edmonton and Calgary, Alberta; and in Delta, Victoria, Vernon, and Penticton, British Columbia. A contact person from each agency, was asked to identify the number of Bis working for the agency who met all of the criteria. A total of 87 individuals were identified across all agencies as potential participants, and all were provided with recruitment letters. From this pool, 65 Bis (75%) agreed to participate and signed informed consent forms. In Alberta, the number of participants recruited from Edmonton and Calgary were .26 and 12, respectively. In British Columbia, the number of participants recruited from Delta, Victoria, Vernon, and Penticton were 9, 10, 5, and 3, respectively. Table 1 summarizes the number of potential and actual participants from each site. In the sections that follow, the demographic characteristics of the 65 participants will be summarized briefly. Gender and age. Two of the participants were males and the remaining 63 were females. The mean age across all participants was 27.3 years (SD = 5.9) and ranged in age from 20 to 46 years.  Experiences of Interventionists 39  Table 1 Number of Eligible and Actual Participants Recruited by Site  Site Location  Number Eligible  Number Recruited  Response Rate  Delta  12  9  75%  Edmonton  43  26  .60%  Victoria  18  10  56%  Vernon  7  5  71%  Penticton  7  3  43%  Calgary  12  12  100%  Total  87  65  75%  Education. To calculate the mean years of education of the group, each of the five educational categories listed on the demographic sheet (high school diploma, college diploma/certificate, Bachelor's degree, Master's degree, other) were converted into the number of years of education they typically represented. Thus, a high school diploma was equivalent to 12 years of education; a college diploma/certificate was equivalent to 14 years of education; a Bachelor's degree was equivalent to 16 years of education; and a Master's degree was equivalent to 18 years of education. A small number of participants who indicated that they were in the process of completing a degree program but had not yet graduated were given credit for the total number of years completed, based on the year equivalents described previously. For example, if a participant checked the category "high school diploma" and also wrote that he or she was in the third year of a Bachelor's degree program, the total years of education were recorded as 15 (twelve years of high school plus three years of university). The single response that was  Experiences of Interventionists  40  provided in the category of "other" (i.e., diploma from a technical institute) was assigned a value of 14 years, equivalent to a college diploma. Based on these estimations, the mean years of education for the entire group was 14.9 years (SD = 1.5) and ranged fro Experience and hours of work per week. The BI's  12 to 18 years.  mean length of experience working  with children with autism was 35.4 months (SD = 34.0, range = 6 to 180 months) across all participants. The mean length of time for which Bis had been employed by their current agency was 18.5 months (SD = 15.0, range = 6 to 100 months). The mean number of hours of work per week across all participants was 29.3 hours (SD = 11.6, range = 4 to 44). Families and children.  The mean number of families with whom the Bis worked was 2.1  across all participants (SD = 0.81), ranging from one to four. The mean number of children with whom the Bis worked was 2.2 across all participants (SD = 0.8), ranging from 1 to 4. Training.  Additional information was also gathered about the training participants '  received from the organization for which they worked. The training information was divided into two main categories: (a) training received when initially hired, and (b) ongoing training. Participants also provided information about specific kinds of training that they had received, for example, attending workshops or lectures. This information is presented in Table 2. As can be seen, participants' training varied widely in terms of both type and quantity. Settings  With the cooperation of each of the aforementioned six organizations, a location was arranged where the participants working for that organization met as a group to fill out all of the research instruments. With the exception of Edmonton, completion of the instruments occurred at the agency's office. In Edmonton, participants met as a group in the lecture hall of a local college following the completion of a staff professional development day.  Experiences of Interventionists \ \  Table 2 Means, Standard Deviations, and Ranges for Initial and Ongoing Training for Participants  Initial Training (total hours)  Ongoing Training (hours per month)  Type of Training  Mean  SD  Range  Mean  SD  Range  Attending workshops/ lectures  32.8  49.3  0-200  3.8  8.8  0-60  Watching training videos  5.4  15.2  0-100  0.52  1.2  0-8  Reading training manual  17.6  42.4  0-200  1.9  3.0  0-15  "Hands on" training  11.0  18.7  0-96  2.2  3.9  0-20  Observing staff  9.4  13.2  0-96  4.8  12.2  0-70  Other  1.6  12.9  0-104  0.5  1.5  0-9  Measurement Pilot Project  Pilot testing was conducted with seven individuals—all experienced Bis who were personal acquaintances of the researcher—to determine whether the potential research instruments would be appropriate, comprehensive, and clear. Pilot participants were instructed to complete the research instruments one at a time, along with a feedback form asking them about their impressions of the instrument (see Appendix A). In addition to the written feedback, interviews were held with each of the participants about the instruments, and notes were made accordingly. Based on the feedback provided by the seven pilot participants, changes were made to the demographic sheet and the instructions accompanying the measures, in order to word them  Experiences of Interventionists 42  more clearly. The results of the pilot project were incorporated into the format of the final instruction sheets and the demographic sheet. The pilot data were not included in the experimental database. Instrumentation  All participants completed three standardized instruments: (a) the Occupational Stress Inventory-Revised Edition (Osipow, 1998); (b) an adapted version of the Family Environment Scale (Moos & Moos, 1994); and (c) the Autism Behavior Checklist (Krug, Arick, & Almond, 1993). In addition, participants completed a demographic form designed for the study and one sheet with three open-ended questions regarding the nature of their work. The order of presentation of the instruments were counterbalanced across participants, to control for an order effect. Occupational Stress Inventory-Revised Edition. The Occupational Stress Inventory-  Revised Edition (OSI-R; Osipow, 1998; see Appendix B) is a measure of three dimensions of occupational adjustment: (a) occupational stress, (b) psychological strain, and (c) coping resources. The OSI-R includes updated normative data for gender and occupation categories, modifications to questionnaire items in the original OSI, and new questionnaire items. Both the OSI-R and OSI are based upon a comprehensive review of the literature on occupational stress, and provide "measures for an integrated theoretical model linking_sources of stress in the work environment, the psychological strains experienced by individuals as a result of work stressors, and the coping resources available to combat the effect of stressors and to alleviate strain" (p. 1). In this model, occupational stress is manifested in specific work roles that have been identified in the literature (see Chapter 1). This occupational stress produces psychological strain that may be expressed in a number of affective and subjective ways (e.g., anxiety), and that may not always  Experiences of Interventionists 43  be expressed in vocational behaviours (e.g., decreased work productivity). The individual's coping resources help mitigate both the level of occupational stress and the strain caused by occupational stress: Thus, there is thought to be a negative correlation between coping resources and occupational stress, as well as a negative correlation between coping resources and psychological strain. In each of the three domains (occupational stress, psychological strain, coping resources), scales in the OSI-R measure either environmental or individual characteristics representing various aspects of occupational adjustment. The three domains are measured with three separate self-report questionnaires, producing three separate scores. For each of the three questionnaires, respondents were asked to rate statements on a five-point Likert Scale ranging from 1 (rarely/never true) to 5 (true most of the time). Occupational stress was measured using the Occupational Roles Questionnaire (ORQ), which is comprised of 60 items representing six scales: (a) Role Overload, (b) Role Insufficiency, (c) Role Ambiguity, (d) Role Boundary, (e) Responsibility, and (f) Physical Environment. These scales were developed to measure six stress-inducing work roles that have been identified in the literature (Osipow, 1998). Role Overload (RO) measures the extent to which job demands exceed resources (personal and workplace) and the extent to which the individual is able to accomplish workloads. Role Insufficiency (RI) assesses the degree to which the individual's training, education, skills, and experience are appropriate for the job requirements. Role Ambiguity (RA) determines whether priorities, expectations, and evaluation criteria are clear to the individual. Role Boundary (RB) measures the extent to which the individual is experiencing conflicting role demands and loyalties in the work setting. Responsibility (R) examines how responsible the individual feels for the performance and  Experiences ofInterventionists 44  welfare of coworkers. Physical Environment (PE) assesses whether the individual is exposed to high levels of environmental toxins or extreme physical conditions. High scores on the ORQ are indicative of high levels of occupational stress. Psychological strain was measured with the Personal Strain Questionnaire (PSQ), which is comprised of 40 items that are classified into four categories: (a) Vocational Strain, (b) Psychological Strain, (c) Interpersonal Strain, and (d) Physical Strain. Vocational Strain (VS) measures the extent to which the individual is having difficulties with work quality or production. Psychological Strain (PSY) determines the extent of psychological and/or emotional problems experienced by the individual. Interpersonal Strain (IS) assesses the degree of disruption in interpersonal relationships. Physical Strain (PS) measures complaints about physical illness and/or poor self-care habits. Similar to the ORQ, high scores on the PSQ indicate high levels of psychological strain. Finally, coping resources were measured using the Personal Resources Questionnaire (PRQ), a 40-item questionnaire divided into four scales: (a) Recreation, (b) Self-Care, (c) Social Support, and (d) Rational/Cognitive Coping. Recreation (RE) determines how much the individual makes use of and derives pleasure and relaxation from regular recreational activities. Self-Care (SC) assesses the degree to which the individual regularly engages in personal activities that reduce or alleviate chronic stress. Social Support (SS) measures the extent to which the individual feels support and help from those around him/her. Rational/Cognitive Coping (RC) measures the extent to which the individual possesses and uses cognitive skills when dealing with work-related stress. Unlike the previous two questionnaires, high scores on the PRQ are not negative indicators—rather, higher scores reflect more highly developed coping resources.  Experiences of Interventionists 45  The OSI-R instruction sheet was modified for the purposes of this study (refer to Appendix B). In addition to the original instructions provided on the test, participants were asked to read the following instructions regarding definitional terms: "The term "SUPERVISOR" refers to your immediate supervisor, the person who supervises you at work and provides you with feedback about your performance. This person may not have the actual title of "supervisor," but s/he immediately oversees your work. The terms "BOSS" and "EMPLOYER" both refer to the ultimate authority in the . organization (i.e., the person(s) considered "in charge" of all employees in the workplace). When answering questions about working with people from other work "DEPARTMENTS, UNITS^ and/or AREAS," the questions are referring to working with other team members in your organization (e.g., a Speech-Language Pathologist). PLEASE COMPLETE A L L T H R E E SECTIONS OF THIS BOOKLET." These definitional terms were included to frame the questions in ways that related more directly to Bis working in support organizations, so that the Bis were able to answer the questions within the context of the organizations for which they worked. Alpha coefficients for OSI-R total questionnaire scores are .88 for the ORQ, .93 for the PSQ, and .89 for the PRQ. Coefficients for individual scales range from .70 to .89, and are comparable to those for the original OSI. Alpha is a measure of internal consistency; thus, it assesses how consistently or how well an instrument measures a particular construct (Huck, 2000). The relatively high alpha coefficients for the OSI-R scales indicate that the scales have sufficient homogeneity (Huck, 2000). Construct validity for the OSI-R was assessed by a factor analytic method. Each of the three questionnaires (ORQ, PSQ, and PRQ) of the OSI-R was separately subjected to a maximum likelihood factor analysis with varimax rotations (Osipow, 1998). Any factor scores of .30 or higher were considered acceptable scores (Osipow, 1998), and the findings are discussed  Experiences of Interventionists 46  using this guideline. The six ORQ scales had clearly defined results. For Role Overlaod (RO), 8 of the 10 highest factor scores loaded on Factor 3 (range .39 to .76). For Role Insufficiency (RI), all 10 of the highest factor scores loaded on Factor 1 (range .26 to .75). For Role Ambiguity (RA), 6 of the 10 highest factor scores loaded on Factor 4 (range .43 to .73). For Role Boundary (RB), 6 of the 10 highest factor scores loaded on Factor 5 (range .41 to .65). For Responsibility (R), 6 of the 9 highest factor scores loaded on Factor 6 (range .40 to .81). Finally, for Physical Environment (PE),.all 9 of the highest factor scores loaded on Factor 2 (range .45 to .84). Factor loadings for the four PSQ scales were less clearly defined. For Vocational Strain (VS), the highest factor scores were distributed between all four Factors, with most of the items loading on Factors 3 and 4 (range .32 to .80). For Psychological Strain (PSY), the highest factor scores were distributed between Factors 1 and 2 (range .30 to .49). For Interpersonal Strain (IS), 8 of the 11 highest factor scores loaded on Factors 1 and 2 (range .30 to .59). For Physical Strain (PHS), 7 of the 9 highest factor scores loaded on Factor 1 (range .42 to .74). Osipow (1998) noted that, for the PSQ, there is "more scale overlap on the factors than is desirable, especially between PSY and IS. These two scales seem to be tapping into very similar strain features" (p. 24). The factor loadings for the four PRQ scales was more clearly defined than those of the PSQ. All 8 of the highest factor scores for the Recreation (RE) items loaded on Factor 2 (range .31 to .76). Five of the 6 highest factor scores for the Self Care (SC) items loaded on Factor 4 (range .32 to .72). All 10 of the 10 highest factor scores for the Social Support (SS) items loaded on Factor 1 (range .36 to .79). All 8 of the 8 highest factor scores for the Rational/Cognitive Coping (RC) items loaded on Factor 3 (range .33 to .71). Osipow (1998) concluded that  Experiences of Interventionists 47  "additional factor analyses should be conducted to further clarify the factor structure of the OSIR" (p. 27). Family Environment Scale.  The Family Environment Scale (FES; Moos & Moos, 1994;  Appendix C) is comprised of 10 subscales that measure the social environment of families. The information from these 10 subscales produces a profile of the family. Together, these 10 subscales assess three underlying dimensions: (a) relationship dimensions, (b) personal growth (or goal orientation) dimensions, and (c) system maintenance dimensions. The relationship and system maintenance dimensions reflect internal family functioning, whereas the personal growth dimensions primarily demonstrate the connection between the family and the larger social context (Moos & Moos, 1994). The FES contains 90 statements in total. Respondents were asked to answer statements as either "true" or "false," although for this study, an additional category ("don't know") was added. This addition will be explained in a later section that describes modifications to the original FES. The relationship dimensions are comprised of three subscales: (a) Cohesion, (b) Expressiveness, and (c) Conflict. Cohesion (C) measures the degree of commitment, help, and support family members provide for one another. Expressiveness (Ex) measures the extent to which family members are encouraged to express their feelings directly. Conflict (Con) assesses the amount of openly expressed anger and conflict among family members. The system maintenance dimensions are comprised of two subscales: Organization and Control. Organization (Org) assesses the importance of clear organization and structure in planning family activities and responsibilities. Control (Ctl) measures the extent to which set rules and procedures are used to run family life.  Experiences of Interventionists 48  Five subscales-represent the personal growth dimensions: (a) Independence, (b) Achievement Orientation, (c) Intellectual-Cultural Orientation, (d) Active-Recreational Orientation, and (e) Moral-Religious Emphasis. Independence (Ind) measures the degree to which family members are assertive, self-sufficient, and make their own decisions. Achievement Orientation (AO) assesses the extent to which activities (such as school and work) are viewed from an achievement-oriented or competitive perspective. Intellectual-Cultural Orientation (ICO) determines the level of interest in political, intellectual, and cultural activities. ActiveRecreational Orientation (ARO) assesses the amount of participation in social and recreational activities. Moral-Religious Emphasis (MRE) measures the emphasis on ethical and religious issues and values. Alpha coefficients for each of the 10 subscales range between .61 and .78. Again, alpha coefficient is a measure of internal consistency, and assesses how consistently an instrument measures a particular construct (Huck, 2000). The authors noted that the subscales were intended to measure relatively broad (as opposed to narrower) constructs, which likely affected the internal consistency—that is, including more diverse items within a subscale resulted in lower internal consistency (Moos & Moos, 1994)., No information was provided regarding the factor analytic structure of the FES. As mentioned previously, the FES was modified somewhat for the purposes of this study. The FES is most commonly used as a tool to assess the social climate of a family as perceived by its family members. However, for this study, the objective was to assess the social climate of a family as perceived by the BI who worked in the family's home. Thus, the FES was adapted in order to allow the Bis to answer the questions based on their own experiences with a particular family. Specifically, any statements in the FES referring to "we" or "our family" were modified  Experiences of Interventionists 49  to read "family members" or "the family." This modification resulted in 62 out of 90 statements being reworded (see Appendix D for modified FES). Furthermore, participants were given the option of answering each statement as "true,',' "false," or "don't know." The category "don't know" was included to accommodate the possibility that participants might not know some kinds of information about the family (e.g., financial matters). It should be noted that any statements that were answered with "don't know" were treated as unanswered items. At least half of the items on a subscale have to be answered for it to be considered valid and scoreable—thus, because there are nine items on each subscale, a minimum of five have to be answered for the subscale to be scored score (R. Moos, personal communication, April 29, 2003). If there are missing items, a correction factor is used to obtain the subscale score; for example, if one item on a subscale is missing, the raw subscale score is multiplied by 9/8 in order to make it more comparable to a 9-item score. This corrected raw score is then looked up in the conversion table to obtain the new standard score (R. Moos, personal communication, April 29, 2003). Any raw scores between the whole numbers given in the conversion table must be interpolated in order to obtain the standard score (R. Moos, personal communication, May 5, 2003). The instruction sheet used for the FES was also modified for the purposes of this study (see Appendix D for modified instruction sheet). First, a definition of "family" was provided to clarify which members were considered family members for the purposes of the study. Second, participants were reminded to answer the statements about the most challenging family that they chose at the beginning of the study, and to only use the category "don't know" only if they were absolutely unable to label a statement as either true or false. Finally, a short paragraph was added, emphasizing that the point of the questionnaire was to collect information about BI's  Experiences ofInterventionists 50 impressions  of the family environment, not to provide a "correct" or "accurate" picture of the  family. Autism Behavior Checklist.  The Autism Behavior Checklist (ABC; Krug, Arick, &  Almond, 1993; Appendix E) is a checklist of behaviours that produces a profile of an individual with autism in comparison to other groups (e.g., individuals who are deaf-blind, individuals who are typical). The checklist contains 57 behavioural characteristics of autism that are divided into five sub-scales: (a) Sensory, (b) Relating, (c) Body and Object Use, (d) Language, and (e) Social and Self Help. The five individual sub-scales produce separate scores and can be compiled to produce one total score. The individual and total scores can be transferred to a profile form that can be used to compare the individual to those in the comparison groups. A total score of 68 or higher has been selected as a "high-probability cutoff point for the classification of autism" (p. 27). In order to make the ABC easier to understand and fill out, the format of the original checklist and the instruction sheet were modified (see Appendix F). The original content (i.e., the items), however, was not changed. Demographic Sheet.  The demographic form is a one-page sheet asking participants to  provide information such as age, gender, length of experience working with children with autism, and training provided by the organization for which they currently work (Appendix G). Open-Ended Questions.  One sheet with three open-ended questions was developed to  gather additional information about participants' work, including information about the most and least enjoyable aspects of their job and about their work-related training and support needs. A fourth question inquired about any additional information that participants wanted to share with the researcher (see Appendix H).  Experiences of Interventionists 51  Procedure Consent Procedures and Ethical Review  An email letter describing the purpose of the study and requesting assistance in recruiting Bis as participants was sent to the Directors of four organizations in British Columbia and two organizations in Alberta. Official letters of consent were obtained from each participating organization and included in an application to the UBC Behavioural Ethics Review Board (BERB) (see Appendix I for Ethics certificate). Consent was also obtained from the Ethics Board of the Vancouver Island Health Authority to recruit participants from the Queen Alexandra Centre for Children's Health in Victoria. The participating organizations were asked to distribute recruitment letters to all of the Bis who were eligible to participate in the study. The recruitment letter described the purpose of the study; invited Bis to participate; and informed Bis of the date, time, and location that the research would take place at each of the sites (Appendix J). In addition, because most of the meetings occurred over the lunch hour, the researcher provided lunch ("free pizza") to those Bis who agreed to participate so that Bis' work schedules would be minimally disrupted. Also, in Edmonton and Calgary, administrators arranged for Bis to participate in the study during scheduled professional development days. Data Collection  At the time of each site visit, Bis who agreed to participate were asked to read and sign consent forms (Appendix K). Participants were then provided with an instruction sheet and asked to follow along while the researcher read the instructions out loud to them (see Appendix L). The instruction sheet provided a brief description of the study procedures, in addition to specific instructions regarding each of the instruments. In addition, participants were asked to select and  Experiences of Interventionists 52  think about the most challenging/difficult family with whom they currently worked, as well as the child with autism who was a member of that family. Participants were told clearly (both verbally and in writing) that they were not to write down or otherwise reveal the name of the family and child that they had chosen. Participants were asked to complete two of the instruments (the Family Environment Scale and the Autism Behavior Checklist) based on their experiences with this family and child only. Completion of all of the forms required approximately 45 to 60 minutes at one sitting. In some cases, Bis had to leave before they had completed all of the research instruments, or were not present to participate at the time of the site visit, but still wanted to participate in the study. Therefore, a total of nine participants—two from Edmonton, six from Victoria, and one from Vernon—were provided with self-addressed stamped envelopes so that they could return the research instruments to the researcher. Seven of the nine participants (one from Edmonton and six from Victoria) mailed the envelopes with the completed research instruments; however, two of the envelopes (one from Edmonton and one from Vernon) were not returned, resulting in a 78% mail-back response rate. Research Questions, Hypotheses, and Data Analyses  For the statistical analyses that will be discussed in the following section, all the data were first entered into an SPSS (version 10.1) file by the researcher. To check for data entry accuracy, 15% of the raw data were randomly selected and then re-entered and checked against the original database. The formula: number of variables entered correctly divided by total number of variables entered, multiplied by 100, was used to calculate data entry reliability. Of the 820 variables originally entered into the database, 819 were entered correctly, resulting in 99.9% accuracy on the data check.  Experiences of Interventionists  53  The six research questions posed in the study, the hypothesis for each, and the method of data analysis for each are summarized in the sections that follow. Question #1: What specific work roles, as measured by the ORQ of the OSI-R (Osipow, 1998), are rated by Bis as being most stressful? Hypothesis: Based on the related research on home visiting (Bennett & Dauncey, 1986; Goodwin, 1983; McBride & Peterson, 1997) and on the qualitative study by Elfert (2002), the work roles rated by Bis as being most stressful will be: (a) Role Overload (i.e., the extent to which job demands exceed personal and workplace resources, and the extent to which the individual is able to manage his or her workload); (b) Role Ambiguity (i.e., the extent to which priorities, expectations, and evaluation criteria are clear to the individual); and (c) Role Boundary (i.e., the extent to which the individual is experiencing conflicting role demands and loyalties in the work setting). Data analysis: Descriptive statistics were calculated to determine the mean, median, and standard deviation of each work role on the ORQ across all participants. The six work role means were compared using a one-way repeated measures Analysis of Variance (ANOVA). This test was selected because the 65 participants were treated as a single group, each member of which was measured on six different scales of the ORQ (i.e., there were six scores for each participant). The one-way repeated measures ANOVA was used to determine if any of the six scale means differed (Huck, 2000). Because this was the case, Tukey tests were used to compare the scores on each of the work role subscales with the others, for a total of 30 pairwise comparisons (the Tukey test assumes that all possible pairwise comparisons will be made)  Experiences of Interventionists 54  (Huck, 2000). The alpha level used was .05. The Tukey test has a similar purpose to the Bonferroni technique, in that it has been designed to minimize Type I error when comparisons are made among a set of group means (Huck, 2000). Instead of compensating for the inflated Type I error risk by adjusting the level of significance, the Tukey procedure adjusts the size of the critical value used to determine whether an observed difference between two means is significant. To compensate for the fact that more than one comparison is made, larger critical values are used. The Tukey test is considered a more conservative test, in that it "provides :  greater control over Type I error risk [than some of the more liberal post hoc procedures], but... at the expense of lower power (i.e., higher risk of Type II errors)" (Huck, 2000, p. 360). Question #2: What is the nature of the relation of Bis' occupational stress, as measured by the ORQ of the OSI-R, to the 10 subscale scores on the FES that describe specific characteristics of the "challenging" families with whom they work? Hypothesis: A hypothesis was not formulated for this question, given that no previous research has been conducted on the relation between occupational stress and characteristics of challenging families to whom Bis provide support. Data analysis: Pearson's product-moment correlations were calculated between the total" ORQ scores on the OSI-R and FES subscale scores for each participant: Thus, each participant was measured on a pair of scores to determine the relation between total ORQ scores and FES subscale scores. The Pearson correlation coefficient is a statistic that indicates the degree of relation or association between two variables, and is an index of linear correlation (Huck, 2000). A two-tailed test of significance was used, with p < .05.  Experiences of Interventionists 55  Question #5; What is the nature of the relation of Bis' occupational stress, as measured by the ORQ of the OSI-R, to the five subscale scores on the ABC that describe behavioural characteristics of a child with autism? Hypothesis: A hypothesis was not formulated for this question, because noorevious research has been conducted on the relation between occupational stress and characteristics of children with autism to whom Bis provide support. Data analysis: Pearson's product-moment correlations were calculated between the total ORQ scores of the OSI-R and the ABC subscale scores for each participant. A two-tailed test of significance was used, with p< .05. Question #4: What is the relation among stress (measured by the ORQ of the OSI-R), strain (measured by the PSQ of the OSI-R), and coping (measured by the PRQ of the OSI-R)? Hypothesis: Based on the theoretical model of Osipow (1998), coping resources were expected to act as a moderator between occupational stress and psychological strain. Baron and Kenny (1986) defined a moderator variable as a "variable that affects the direction and/or strength of the relation between an independent or predictor variable and a dependent or criterion variable" (p. 1174). In other words, it was predicted that individuals with more highly developed coping resources would experience less psychological strain. Data analysis: A linear hierarchical regression model was used to analyze the relationships between stress, coping resources, and strain (Baron & Kenny, 1986). In particular, the analysis focussed on how coping acted as a moderator variable between stress and strain. According to Baron and Kenny, "moderation implies that the causal relation between two variables changes as a function of the moderator variable. The statistical analysis must measure and test the differential effect of the independent variable on the dependent variable as a function  Experiences of Interventionists 56  of the moderator" (p. 1174). Thus, the analysis tested how the dependent variable (strain) was influenced by the product of the independent variable (stress) and the moderator variable (coping resources). Moderator effects are indicated by the significant effect (p < .05) of (stress X coping) while stress and coping are both controlled in the regression equation. Question  #5: What do Bis perceive to be the most and least enjoyable aspects of their work?  Hypothesis:  Based on the qualitative study by Elfert (2002), the most enjoyable aspects  of Bis' work will be related to child variables (e.g., having a significant influence or impact on a child with autism's life by working intensively with him/her). The least enjoyable aspects of Bis' work will be related to parent or family variables (e.g., feeling pressure from the family to "cure" the child with autism, struggling to maintain professional boundaries with a family). Data analysis:  The data from the open-ended questions related to this issue were  evaluated using a content analysis based on a classification of the responses into categories and subcategories. Content analysis is a method of summarizing and analyzing messages in a systematic, carefully constructed way. These messages may come in a variety of forms, such as visual images, written text, or verbal interactions. The goal of analysis is to reduce the messages into common categories, or codes that are representative of the data set from which they came, in order to explain a particular phenomenon (Neuendorf, 2002). For this study, two sets of responses were analyzed - one related to the "most enjoyable" and one related to the "least enjoyable" aspects of Bis' work. Participants' written responses were analyzed using an "emergent coding" of the content, in which a "coding scheme is established after all responses are collected; then, systematic content analysis is conducted applying this scheme to the responses, with appropriate reliability assessment" (Neuendorf, 200, p. 194). Thus, in emergent coding, there is no a priori classification of categories. Emergent  Experiences of Interventionists 57  coding was considered to be appropriate for this data set because no standard classification or coding scheme existed in this area; thus, a new coding scheme was required. The researcher first entered each participant's written responses into a database that was categorized only by participant number. If a sentence or phrase contained more than one idea or concept, it was divided into the appropriate number of concepts and entered separately into the database. If a participant wrote out a number of comments that were visually separated on the page but contained similar ideas or concepts, they were entered as separate responses. (This was based on the researcher's assumption that the participant separated similar-appearing comments because he/she considered them to be separate ideas.) After all the responses were entered into the database, the researcher began the process of reading and re-reading each participant's response set, searching for common themes among all of the responses. The computer database was reconfigured on an ongoing basis to reflect the emerging themes accurately. This process eventually resulted in a set of finite response categories (see Appendixes M and N for the content analyses of the most enjoyable and least enjoyable aspects of BI's work, respectively). Next, the researcher developed comprehensive descriptions of each of the categories that emerged from the database, so that each category and subcategory was clearly operationalized. The categories that were created were (a) exhaustive, so that all of participants' responses were appropriately represented in the categorization; and (b) mutually exclusive, so that each of the categories was independent from the others (Neuendorf, 2002). These categorical descriptions were used to create separate code books for each of the qualitative questions (see Appendixes O and P). A second rater (a graduate student) was trained by the researcher regarding how to use the coding scheme to evaluate participant's responses and sort them into the established categories and subcategories. If there were any disagreements between the coder and researcher  Experiences of Interventionists 58  regarding how to categorize a response, the quotation was examined and a discussion ensued. A response was only recoded and placed in a new category if both the researcher and the coder agreed that it would be more accurate and appropriate to do so. A total of six hours of training were provided, and t  criterion for training mastery was met when the second rater achieved  85% or better reliability with the researcher over three consecutive sets of responses for both categories and subcategories. After the training phase was complete, approximately 35% of the sample (23 sets of written responses) was randomly selected and independently coded by both the researcher and the coder, and a percentage agreement was calculated to determine the intercoder reliability. This type of calculation was deemed appropriate to use, given that the analysis involved precise categorical coding (Neuendorf, 2002). The formula used was agreement divided by [agreement plus disagreement], multiplied by 100. Table 3 and Table 4 present the intercoder reliability results for the questions pertaining to least and most enjoyable aspects of BPs work, respectively. Question #6: What  additional training and support do Bis believe they need to be more  competent, skilled, and successful in their work? Hypothesis:  It was not possible to formulate a hypothesis for this question, given that  there has been no research conducted on the work-related training and support needs of Bis. Data analysis:  The data from this open-ended question were evaluated using the content  analysis described in detail in the previous section (see research Question #5). Appendix Q presents the content analysis for additional training and support needs of Bis, and Appendix R presents the code book used to categorize the written responses. Table 5 presents the intercoder reliability results for the question pertaining to additional training and support needs.  Experiences of Interventionists 59  Table 3 Inter coder Reliability for Question #1 ("What do you feel is/are the most challenging or stressful aspects of your job as a behaviour interventionist?")  Category Child  No. agreements  No. disagreements  Total no. responses  Percent agreement  Engaging/motivating  2  0  2  100  Lack of progress  5  0  5  100  Challenging behaviour  9  1  10  90  Other  1  0  1  100  Sub Category  Total  Family  17  1  Working in the home  7  18  94  0  7  100  Conflict/inconsistency  12  1  13  92  Expectations  3  0  3  100  Other  2  1  3  67  24  2  26  92  17  1  18  94  Total  Team  Conflict/inconsistency  Total  Job  Total Column totals  17  1  18  Organizational issues  94  6  0  6  100  Isolation  6  1  7  86  Time pressure  7  0  7  100  Job performance  8  0  8  100  Length of session  2  0  2  100  Other  1  0  1  100  30  1  31  97  88  5  93  95  Experiences of Interventionists 60  Table 4 Inter coder Reliability for Question #2 ("What do you feel is/are the most rewarding or enjoyable aspects of your job as a behaviour interventionist? ")  Category Child  Sub Category  0  37  100  Forming relationship/ having fun/playing  14  0  14  100  Other/don't know  2  1  3  67  53  1  54  98  18  0  18  100  18  0  18  100  6  0  6  100  6  0  6  100  Helping families  Working as a team  Total  Job  Percent agreement  37  Total  Team  Total no. No. disagreements responses  Learning/success  Total  Family  No. agreements  Positive aspects of job/work environment Other/don't know  100 7 3  0 0  7 3  100  10  0  10  100  10  0  10  100  Total  10  0  10  100  Column totals  97  1  98  99  Total  Other  General quotes re: enjoyment of job  Experiences of Interventionists 61  Table 5 Intercoder Reliability for Question #3 ("Please describe any additional training and/or support that would help you to be more successful, skilled, competent, etc. in your work. ")  Category  Sub Category  No. agreements  Total no. No. disagreements responses  Percent agreement  Increased supervision/ support  17  0  17  100  Total  17  0  17  100  Increased contact with Bis  3  0  3  100  Total  3  0  3  100  Training and support re: family issues  4  1  5  80  Total  4  1  5  80  Changes to job/work environment  5  0  5  100  Total  5  0  5  100  7 4 5 2 1 5 2 2 6 3  0 0 0 1 0 0 0 0 0 0  7 4 5 3 1 5 2 2 6 3  100 100 100 67 100 100 100 100 100 100  37  1  38  97  66  2  68  97  Training/skill dev't in:  Total  SLP strategies OT strategies Behaviour mngmnt Teaching/therapy Organizational info Materials/research Activity ideas Data collection Other job training General workshops  Column totals  Experiences of Interventionists 62  CHAPTER 3 Results Determination of the Impact of Demographic and Training Differences Across Sites  The purpose of this study was to investigate the experiences of Bis who work one-to-one with children with autism in families' homes. The Bis were recruited from six different sites located in two provinces, and varied with respect to key demographic variables (e.g., level of education, amount of training). These demographic differences raised the issue of whether the data could be treated as though it came from one group of 65 participants, or whether the intersite variability would significantly impact the outcome measures and require that the data be analyzed separately for each site. Thus, a series of one-way analyses of variance (ANOVAs) were computed to determine whether there were significant differences between the sites with regard to the following demographic variables: age, years of education, months of experience with children with autism, length of time employed, hours of work per week, number of families with whom the Bis worked, number of children with whom the Bis worked, hours of initial training, hours of ongoing training, and hours of total training (total hours of training provided was computed by adding the hours of initial training and the hours of ongoing training for each participant). The results of these analyses are presented in Table 6.  Experiences of Interventionists 63  co  co  1-2  ^H  MD  o o  00 00  CO  ON ON  I*,  *  # CN  MD  MD  CN CN  CO  ON  MD  in co ©  MO  o o o V  CN  CO  0O  t>  CN  *  *  o o o V  o o o  ©  00  CN  T—H  ON  od ^  ON^-=3r©in©COMD O0 CN OO ^1_; i n "3- O O mii O N T - J o CN CO t o — i <—i CN <—i CN © CN ©  r-  o o V  v'  CN IO  1  MD  *  »-H  o CO  —; CN  od © "o o o  CN CO CO -si-  ON  ho  rm CN xj -sf CN MD CN 1  ho  CN  "  o  O  cn  O CO  ON  _<  CN  m © CN  CN  —< S -  c--  '©  ©  MD ON , MD MD  CN CN ^  Ci'  c o -rf CO © ri w CN *-<  ^  ON  CO r-l  ^H  CN  CN  ^t- i n CN d  TJ- m CN ©  © ON  C  ^t00  in ^: CN  in  ^  in  "S  o  a  3 e3 cd >  cd  cd CD  PH 00  <  C  c  <U  /—\  cd cn ;3 c3  •  —  ^  N  O  £  -5  „, H,  ft'rt g W cd H  C+H  HG -4—»  N  g  .2  clZ  ~  2 ^  h- i^l  ON (  ^H r- r-  f  i  ^  2  O h  ^  ^  2  a. 3  u, O  60 C 0)  00  .S HS .S co  'cd  ^  o <u S .„ ca a  Cl O o ^ f f i  ^  © ^H  MD MD MD co CO MD O N c o CN  -  oo  in  o <U  -  • r--  T3  *I o  CO  MD  t—i  oo >o  m  ^ s ^ )  ,  CN m  r-  3 CN CN  • t~- ©  CN MD M D T f C O M D ^ C O ^ ^ ^ ^ g ^ T t - c N C N i n c o o c o c o c o ' , — ; , ; • T t ~ «^ c N c N c N - H C N - H $ o •—CO v  ©  •^  h  fa oo  <^  g g2  ©  ON  CN ° ^ ° °  ^  CN CN  oo °°. Co °? ^ °^ ^ ^ oo F -  <o Co co Cn  o d  2  cd „  O 00  -S C  ^  cd  •a £ c ' 3 o  c o 'S  Experiences  of Interventionists  64  Significant differences between sites were found for 5 of the 10 variables examined: years of education, hours of work per week, initial training hrs, ongoing training hrs, and total training hrs. Further statistical analysis was needed to determine whether the site differences in these five variables had an impact on the three outcome variables that could have been affected by those differences, namely occupational stress (ORQ scores), strain (PSQ scores), and coping (PRQ scores). Pearson product-moment correlations were calculated among years of education, hours of work per week, initial training hrs, ongoing training hrs, and total training hrs; and ORQ, PSQ, and PRQ scores. The results are presented in Table 7. Table 7 Correlations Among Demographic Variables and Stress, Strain, and Coping Scores  Stress  Strain  Coping  (ORQ scores)  (PSQ scores)  (PRQ scores)  Years of education  .29 (p = .02)*  -.03, ip =.84)  .003 ip =.98)  Hours of work/wk  .04 (p =.11)  .02 ip =.86)  -Alip=.\S)  Initial training hrs  .08 (p =.54)  -.10 O =.44)  .20 (j? =.12)  Ongoing training hrs  .11 {p =.38)  -.02 ip =.86)  .13 O =.31)  Total training hrs  .11 (p =.38)  -.01 ip =.96)  .14 ip =.21)  Variable  *significant correlation at p <_.05  As is evident from Table 7, there was a moderate positive correlation between years of education and stress (ORQ) scores. No other correlations were significant. On the basis of this analyses, which indicated that years of education was the only one out of 10 key demographic and training variables that both distinguished the six sites and was moderately correlated with any of the dependent measures, a decision was made to treat the 65 participants as a single group.  Experiences  of Interventionists  65  Analysis of Data Pertaining to the Research Questions  In the following sections, the six research questions will be presented, along with the hypothesis and results for each. Question •#!: What specific work roles, as measured by the ORQ of the OSI-R (Osipow, 1998), are rated by Bis as being most stressful?  Hypothesis: The three work roles rated by Bis as being most stressful will be Role Overload (RO; the extent to which job demands exceed personal and workplace resources); Role Ambiguity (RA; the extent to which priorities, expectations, and evaluation criteria are clear); and Role Boundary (RB; the extent to which the individual is experiencing conflicting role demands and loyalties at work). No hypothesis were made with regard to the remaining three subscales, Role Insufficiency (RI; the extent to which the individual's training, education, skills, and experiences are appropriate to job requirements); Responsibility (R; the extent to which the individual has or feels a great deal of responsibility for the performance and welfare of others on the job); and Physical Environment (PE; the extent to which the individual is exposed to high levels of environmental toxins or extreme physical conditions) on the basis of past research. Results: Table 8 shows the means and standard deviations for each of the six OSI-R subscale scores. Table 8 Means and Standard Deviations for the OSI-R Subscales  Subscale Role Overload (RO) Role Boundary (RB) Role Ambiguity (RA) Role Insufficiency (RI) Responsibility (R) Physical Environment (PE)  Mean 53.3 53.1 50.8 50.2 46.6 48.1  Standard Deviation 9.3 11.3 9.7 8.7 8.9 5.5  Experiences of Interventionists 66  A repeated measures ANOVA with six levels (RO, RB, RA, RI, R, and PE) was used to determine whether significant differences existed among the three subscales of interest (RO, RB, RA) and the remaining three OSI-R subscales. The result of a repeated measures ANOVA was significant, F(5, 315) = 9.65,p <.0001, indicating that there were significant differences between at least one pair of means. Tukey tests were then conducted to determine the source(s) of the differences. Table 9 shows the results of the Tukey tests. Table 9 Tukey Pairwise Comparisons Between Work Role Scores on the OSI-R (Osipow, 1998)  Mean difference and p value Work Role  RO  * significant difference at p < .05  RB  RI  RA  R  PE  Experiences of Interventionists 67  The mean scores for both Role Overload (RO) and Role Boundary (RB)) were almost identical (53.3 and 53.1, respectively), and both scores were significantly higher than the means for Role Ambiguity (RA) (50.7), Role Insufficiency (RI) (50.2), Physical Environment (PE) (48.1), and Responsibility (R) (46.4). Thus, as predicted, RO (i.e., the extent to which job demands exceed personal and workplace resources, and the extent to which the individual is able to manage his/her workload) and RB (i.e., the extent to which the individual experiences conflicting role demands and loyalties in the work setting) were both rated by Bis as being significantly more stressful than all of the other work roles. The third work role hypothesized to be in this group was RA (i.e., the extent to which priorities, expectations, and evaluation criteria are clear to the individual), which had the third highest mean but was significantly lower than both RO and RB (as well as significantly higher than R). Thus, the hypothesis was partially confirmed: both RB and RO scores were significantly higher than those for RI, R, and PE. However, RA, which was predicted to be in the RB/RO group, was significantly lower than these two scores. Question #2: What is the nature of the relation of Bis' occupational stress, as measured by the ORQ of the OSI-R, to the 10 subscale scores on the FES that describe specific characteristics of the "challenging" families with whom they work?  Hypothesis: A hypothesis was not formulated for this question, because no previous research existed on the relation between occupational stress and characteristics of challenging families to whom Bis provide support. Results: Pearson product-moment correlations were calculated to determine whether there were associations between the total ORQ scores and the 10 FES subscale scores. No statistically significant relationships of occupational stress to any of the 10 characteristics of  Experiences of Interventionists 68  challenging families to whom Bis provided support were found. Table 10 presents the correlations between total ORQ scores and the 10 FES subscale scores. Table 10 Correlations Between FES Subscale Scores and ORQ Total Scores  FES Subscale  a  Correlation (r)  n  P  Cohesion  -.091  63  .48  Expressiveness  -.228  58  .09  Conflict  .050  61  .70  Independence  -.205  61  .11  Achievement Orientation  -.075  61  .56  Intellectual-Cultural Orientation  -.131  59  .32  Active-Recreational Orientation  -.240  59  .07  Moral-Religious Emphasis  -.056  51  .70  Organization  .105  63  .41  Control  .046  62  .72  a  The number of participants was not equal for each subscale because some subscales contained too many  unanswered items and were not scored (see Chapter 2 for explanation of scoring process).  Question #3: What is the nature of the relation of Bis' occupational stress, as measured by the ORQ of the OSI-R, to the five subscale scores on the ABC that describe behavioural characteristics of a child with autism?  Hypothesis: A hypothesis was not formulated for this question, because no previous research existed on the relation between occupational stress and characteristics of children with autism to whom Bis provide support.  Experiences of Interventionists 69  Results: Pearson product-moment correlations were calculated to determine whether there were associations between the total ORQ scores and the five ABC subscale scores. A significant correlation was found between total ORQ scores and the Sensory subscale scores of the ABC (r = .25, p = .04). Thus, higher levels of occupational stress were related to higher levels of sensory-related child behaviours. Such behaviours include, for example, covering the ears at many sounds and staring into space for long periods of time. Although this was a statistically significant correlation, the coefficient of determination (r ), which reflects the 2  strength of the association between two variables (Huck, 2000), was only .07. Thus, only 7% of the variability in ORQ scores was associated with the variability in Sensory subscale scores. In addition, a significant correlation was found between the total ORQ scores and the Relating subscale scores of the ABC (r = .37, p = .002). Thus, higher levels of occupational stress were associated with higher levels of social un-relatedness in the children. Behaviours for this subscale include, for example, having no social smile, being unresponsive to other people's facial expressions/feelings, and resisting being touched or held. The coefficient of determination  2  *  (r ) was .14, reflecting a moderate degree of association between these two variables. Thus, 14% of the variability in ORQ scores was associated with the variability in Relating subscale scores. No significant correlations were found between the total ORQ scores and the Body and Object Use subscale scores (r = . 2 3 , = .07); the Social and Self Help subscale scores (r = .19, p = .13); or the Language subscale scores (r = .\3,p = .29). Thus, occupational stress was not significantly related to the behavioural characteristics of children with autism that are reflected in these three subscales. Question #4: What are the relations among stress (as measured by the ORQ of the OSI-R), strain (as measured by the PSQ of the OSI-R), and coping (as measured by the PRQ of the OSI-R)?  Experiences of Interventionists 70  Hypothesis: It was predicted that coping resources would act as a moderator between occupational stress and psychological strain. In other words, it was predicted that individuals with more highly developed coping resources would experience less psychological strain. Results: First, Pearson product-moment (zero order) correlations were calculated to determine the relations among the three dependent variables (ORQ, PSQ, and PRQ scores). The results are presented in Table 11. Table 11 Correlations Among Stress (ORQ), Strain (PSQ), and Coping (PRQ) Scores  Scores  Stress (ORQ)  Stress (ORQ) Strain (PSQ) Coping (PRQ)  Strain (PSQ)  Coping (PRQ)  .60 (• .oool)  -.39 (.002) -.60 (<.0001)  ^^^^^^^^^^^^^^^^^^^^^^^^^^^B  Note, p values are in parentheses  As seen in Table 11, the three dependent measures were highly correlated. Stress and strain were positively correlated such that as stress increased, so did strain. Both stress and strain were negatively correlated with coping such that as coping increased, both stress and strain decreased and vice versa. A hierarchical linear regression with strain as the dependent (criterion) variable, stress as the independent (predictor) variable, and coping as the moderator variable was conducted with regard to this question. The results of a linear regression found that stress (ORQ) scores were significantly positively related to strain (PSQ) scores (Beta = .51, p < .0001). In other words, higher levels of stress were associated with higher levels of strain. A significant negative correlation was also found between coping (PRQ) scores and strain (PSQ) scores (Beta = -.39,p  Experiences of Interventionists J \  < .0001). Thus, higher levels of coping were associated with lower levels of strain, and higher levels of strain were associated with lower levels of coping. Together, stress and coping accounted for 56% of the variance in strain (R dj = .56). However, there were no significant 2  a  effects for the interaction of (stress X coping) on strain (Beta = .07, p = .41). That is, coping was not found to have significant moderating effect on the relations between stress and strain. Question #5: What do Bis perceive to be the least and most enjoyable aspects of their work?  Hypothesis: It was predicted that the least enjoyable aspects of Bis' work would be related to parent or family variables (e.g., feeling pressure from the family to "cure" the child with autism, struggling to maintain professional boundaries with a family) and the most enjoyable aspects of Bis' work would be related to child variables (e.g., having a significant influence or impact on a child with autism's life by working intensively with him/her). Results for Most Challenging Aspects. A content analysis of responses to the question about the most stressful or challenging aspects of BI's work produced four broad categories, each with its own set of subcategories. These are summarized in Table 12, along with the frequency of responses occurring in each category. As can be seen, Job variables were described as being most stressful, accounting for 38% of the total number of responses. These were followed by Family (27%) and Team variables (22%), which were almost equivalent with regard to frequency. The least stressful aspect of the job pertained to Child variables, which accounted for only 13% of all responses. Thus, the hypothesis for this question was not confirmed: Although Bis did report that family variables were a stressful/challenging aspect of their jobs, they were not the primary source of stress.  Experiences of Interventionists 72  Table 12 Frequency Count and Percentages of Written Responses to Question #1 ("What do you feel are the most challenging or stressful aspects of your job as a behaviour interventionist? ")  No. of respondents  No. of responses  %of category  %of total  19  31  32  12  15 14 16 5 5  21 18 18 5 5  22 18 18 5 5  8 7 7 2 2  N/A  98  100  38  21  32  46  12  19 4 5  29 4 5  41 6 7  11 2 2  N/A •  70  100  27  33  58  100  22  N/A  58  100  22  16 5  18 5  55 15  7 2  5 3  5 5  15 15  2 2  Total  N/A  33  100  13  Column totals  N/A  259  N/A  100  Category Job Variables  Sub Category Job performance/job responsibility Organizational/agency issues Isolation Time pressure Length of session Other/don't know Total  Family Variables  Working in a family's home Conflict/inconsistency/ lack of support Family expectations Other/don't know Total  Team Variables  Conflict/inconsistency/ lack of support Total  Child Variables  Challenging behaviour Lack of progress Engaging/motivating the child Other/don't know  Experiences of Interventionists 73  Five main issues were reflected in the Job category, which was related to working for the employing organization or to aspects of the job itself. The first subcategory, job performance/job responsibility, dealt with general issues of job performance. For example, Bis wrote about feeling (generally) unprepared to handle situations, the challenges of coming up with innovative ways to get work done, and feeling responsible for the welfare and success of the child. The second category was organizational/agency issues, and included a variety of stressors such as not being paid for sick days, crowded office/physical workspaces, and having no opportunity to move up in the organization. The third subcategory was isolation, and related to Bis working alone with the child. Many respondents described feeling isolated and lonely, and felt that they did not have enough support or contact with other team members on a regular basis. The fourth subcategory was time pressure. A number of Bis indicated that they did not have enough time to meet program goals, or that they were forced to take work home with them because of a lack of preparation time during the work day. The fifth subcategory was the length of instructional sessions. Some Bis described having to work 3 to 5-hour shifts with a child and felt that this was too long for both parties. Finally, the subcategory "Other/don't" know was included for jobrelated quotations that were either too vague to categorize accurately or did not fit into any of the other five subcategories. For example, one respondent mentioned the stress of "driving in the snow," which was categorized here. Overall, it appeared that many Bis experienced considerable difficulty with their work environments and/or employers. In the Family category, participants described three broad issues as being stressful. The most common of these was working in a family's home. Many participants noted that it was difficult to work in the family's private living space and to be exposed to private information about and private moments between family members. For example, some participants described  Experiences of Interventionists 74  getting "caught up" in a family's personal problems, or witnessing arguments between the parents. Others talked about struggling to maintain professional boundaries with families, so as not to become too personally involved in their lives. The second family issue pertained to conflict, inconsistency, or lack of support between the BI and family members. Almost half of all responses described Bis' frustration when they worked hard to make gains with a child and felt that the child's family did not "follow through" with established goals outside of formal intervention times. Some participants described feeling conflicts between their own beliefs and a family's beliefs about what was "best" for the child regarding intervention. Finally, the third stressor pertained to parents' expectations regarding their children's progress. Some Bis felt that parent's expectations were too high or unrealistic, and noted that they felt pressure to "fix" the child or help the child improve more quickly than was reasonable. The category of "Other/don't know" was used for quotations that were either too vague to categorize accurately or that did not fit into one of the three family subcategories. For example, the quotation "dealing with family members" was placed in this subcategory. All of the responses in the Team category pertained to conflict, inconsistency, and/or lack of support between team members. A number of Bis wrote about not having enough support and/or supervision from senior staff members such as supervisors, occupational therapists (OTs) and speech-language pathologists (S-LPs). Other Bis described poor communication between team members, or conflict between team members with respect to meeting the needs of a child and family. Finally, in the Child category, participants described three main issues as being stressful. The most common of these was managing children's challenging behaviour; some participants described being physically hurt by a child, or struggling to manage challenging behaviours  Experiences of Interventionists 75  effectively. Second, participants found it challenging to try and keep children motivated or engaged while doing one-to-one intervention. They described having to use extensive verbal or hand-over-hand prompting to help children complete activities, and struggling to make activities both fun and interesting for the child. Some children's lack of progress or improvement was also identified as being stressful; participants described feeling helpless and disheartened by slow improvement. Finally, a fourth category of "Other/don't know" was used for responses that referred to child variables but were either too vague to categorize accurately or that did not belong in one of the above three categories. For example, the quotation "lack of conversation if the child is nonverbal" was placed in this category. Table 13 provides a representative sample of quotations from participants for each of the categories and subcategories in Question #2.  Experiences ofInterventionists 76  cd  Cl  o  o o  cn •~  CD  oo  ,  -*-» o  Q,  ,  ^  T3  »-H  »-H <-1  CD _> '-4—»  —  CL,  d  Cd  a  CD oo CD S-,  ,  13 §  s se  Ia  8  X! 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X  CL)  ' i-H  t3  cd cn  CD  Co  ts  cn  60fe  00 „ cd " . <L>  P§  Xi OH,  a  oo  CL,  2  in  O  13  CL, CL,  CD  d 0  O  I  a2 ^ »2  2?  0  ^  a  fd 60  d  o c  " X)  O  CD  2  UQ £  ^  ==  o 2 cd x!  J  >  d  U  o  ll  "c o  113  ^3  ,  C/3  cn  O  CD CD  CD  rd  I  U >  x> o  PH  'I cd  >  cn  _ 3  a  .2  a* fe CD  H  cd  >  CD  13  _cd  rd 'C  XI cd  O  >  o  60 B3  Experiences  of Interventionists  77  Results for Most Rewarding Aspects: A content analysis of responses to the question about the most rewarding or enjoyable aspects of Bis' work produced five broad categories, each with its own set of subcategories. These are summarized in Table 14, along with the frequency of occurrence of each. From this table, it is clear that Child variables were described as the most rewarding/enjoyable aspects, accounting for 55% of the total number of responses. These were followed by Family variables (17%); and then by Team (11%), Job (9%), and Other variables (8%), which were nearly equal in frequency. Thus, the hypothesis for this question was confirmed: Bis reported that child variables were the primary source of reward in their jobs. Responses in the Child category fell into two main subcategories, (a) learning/ progress/success/improvement, and (b) establishing a relationship/connection with the child. In the first subcategory, Bis wrote about the reward of helping children learn new concepts and skills such as saying their first words and becoming more independent in daily living skills. Many Bis mentioned feeling positive about the fact that they were making a significant difference in a child's life. In the second subcategory, Bis described the enjoyment of establishing a relationship or connection with a child, and of having fun or playing with a child. They wrote about feeling good when they received affection or eye contact from a child, were accepted and trusted by a child, and/or heard a child laugh or saw a child smile for the first time. The subcategory of "Other/don't know" was used for child- related responses that were either too vague to categorize accurately or that did not belong in one of these two subcategories. For example, the quotation "working with the children" was categorized here.  Experiences of Interventionists 78  Table 14 Frequency Count and Percentages of Written Responses to Question #2 ("What do you feel is/are the most rewarding or enjoyable aspects ofyour job as a behaviour interventionist? ")  No. of  No. of  %of  %of  respondents  responses  category  total  59  78  61  34  30  42  33  18  7  7  6  3  N/A  127  100  55  35  40  100  17  N/A  40  100  17  20  24  100  11  N/A  24  100  11  13  17  81  7  4  4  19  2  N/A  21  100  9  16  19  100  8  Total  N/A  19  100  8  Column totals  N/A  231  N/A  100  Category  Sub Category  Child  Learning/progress/succe  Variables  ss/ improvement Establishing a relationship/ connection; playing/having fun Other/don't know Total  Family  Helping families  Variables Total  Team  Working as part of a  Variables  team Total  Job  Positive aspects of  Variables  job/agency/ work environment Other/don't know Total  Other  General quotes re: enjoyment of the job and making a difference  Experiences of Interventionists 79  There was one main subcategory in the Family category, which pertained to helping families in general and establishing relationships with family members. The quotations in this subcategory described the rewards of helping families succeed and make progress, being appreciated by families, developing close relationships with families, and making a difference in families' lives. All of the quotations in the Team category were grouped together and referred to the reward of working as part of a team, collaborating with team members, being acknowledged and appreciated by team members, and receiving support from team members. In the Job category, all of the quotes pertained to positive aspects of the job/agency/work environment. These included having a flexible work schedule, the absence of "office politics," and working in a variety of contexts. Again, a subcategory of "Other/don't know" was used for job-related quotations that were either too vague to categorize accurately or that did not fit into one of the two subcategories. For example, the quotation "doing crafts" was placed in this category. A final category was created to incorporate any general quotations about job performance and enjoyment of the job. Many Bis wrote about "making a difference" and "seeing progress," but it was not clear whether they were referring to seeing progress in the child or the family. Thus, a decision was made to group these general comments in a separate category. All of the quotations in this category referred to making a difference; seeing improvements; and experiencing successes, smiles, and/or laughter. Table 15 provides a representative sample of quotations from participants for each of the categories and subcategories in Question #2.  Experiences of Interventionists 80  CU  «  T3  £  ON  * cd ci cu S o  PH  CO  K  CO  £•§ S  -d  cl o td -k-»  o 3  a  >  cl cu  •4-*  on CU  CH CU  PH  2  cn  TJ  C cd CU  C  W  o  ,  ti " C+H CU  ^*H  CD  M  CD  cu  Fj « o a .s CD  ra  > X  +3  '5  cd o ? -d cd cu — >H _o ,3  /IN  N cd  CD 'on Pi cn  1 / 5  o CH a CD CD  O CuX  kH  CD  CD  o 'M  kH  CD  o o  X  cd  X  ">  CD  O  CD  O  cd t  SH  cu kH  CD  &  -t—»  H-H  Cl cd  bO  • l-H » CO  a  0 3  X  Cu 3 O  Cu  O  H-H  o  O  CD  Cu  <H  3  o oo a  -t—»  O  TJ  CD  X  CD  X  oo  SH  CD  on  Cu  'cu kH  Cu  cu XI  Cl  Cl  1|2  a o on  3  TJ  on  ^  ^1-  CD  x  cd r3 (u xi > o cd cd XI  >;.SH SH •*  PH  Cu  ON  cl  oo  TJ  • H  CD  X  .»  TJ CH Cl  CU TJ  CD  f1  O  CD  o  bO g  CN  Cu O  TJ  cd  td  bO  a  CD  5 cd  SH  00  cd  00  X  00  CH  J3  a  SH  O  o  cu  on  IbO  >. o  -t—»  3  '5  ID >  CD  X  bO  a  _o  a  cd  X  Cl  • i-H  a  Ix:  O  1  CD  Q  '1  o C  id  O x 3  SH  O  OC  cu td  u  a CD  >  »H  bO  CH  _OH  "oi)  *  a  a  o on n  a  O  Le  t>0  CD  on on CD  ro ro  kn  CD  o  SUi  o ox) cu  CD  x  la "cd  60  kH  >  cd 00  j 2  =5  '3  o JS PH  CU  on •*-» cj  Cu  HH  kn  O  "CD  on  on cu  CD  J D  r3  cd  a "5 cd «  PH  >  _  X  a  .sa  cd a <u cd  H  o ti  on > , CD cd cj cj  a  a x>  >  X.  o  kH  Cu<~  00  00  cd  CD  on cd  .c3  on  3 2 .S 2 c3 u >  o  S  i3 .a  a  <+H  O  a o a  T3  X  «  c  s  l)  a  -H  bO O  a  cs  .a  PH  .2,  CD  a  >  g  £ TJ  o a  cr. a cd cd CD bO  ii  o Sa  ix;  1  G  kH CD  kH  O  on cu cd  +H  CD  aO  bO CD  kH CD  X  1^  Experiences of Interventionists 81  Question #6: What additional training and support do Bis believe they need to be more competent, skilled, and successful in their work?  Hypothesis: It was not possible to formulate a hypothesis for this question, because no previous research existed with regard to work-related training and support needs of Bis. Results: A content analysis of responses to this question produced five broad categories. The largest number of responses to this question pertained to Bis' desire for training in specific areas of skill development for the children with whom they worked (48%). This was followed by a desire for increased supervision and support (24%), increased contact with other Bis (10%), increased training related to families and parental issues (8%), and changes to the work environment or employing organization (8%). A small number of comments were made in other areas as well, and were categorized as "Other" (2%). Table 16 provides a frequency count and percentages of written responses by category and total for Question #3. Quotations in the first category, Training and Skill Development, were divided into 10 subcategories, depending on the focus that was identified for training. These included: (a) SLP strategies - this subcategory included general training related to speech and language development in the child, as well as specific speech-language techniques such as the Picture Exchange Communication System (PECS), visual supports, and sign language. (b) OT strategies - this subcategory pertained to occupational therapy techniques, including specific information and training on dealing with sensory issues. (c) Behaviour management - this subcategory included comments related to how to manage a child's challenging behaviour, including non-violent crisis intervention and positive behaviour support.  Experiences of Interventionists 82  oo oo NO  M-H  o  o, 60  2  CM X~ £  <u  Tj  -  cn  ON  m  CN  NO  m  CN CN  00  CN CN  O  o  H—>  O o  o ©  OO  o o  o o o o © o  o o  00 oo  © o o CN <N ©  <  o  cn CD r/l  a  2 £22  cn CU  V©  OO  00  oo ^>  00  in  Wt CO fO  ©  00  kn  cn  00  <m  0 0 NO  cn  NO  m  <  ^ <N  0)  O  kH  CU -kH  3  S  CU  a  o  r o op oo oi  ST  g  cu  Cd  .a § .a a 00  O  =3 00  X  cu  oo  kH  o « cu  XI  CU  "55  O  •  X  cu  kH  60  r„  "K '»H  • H  <0  00  C  (3  X  cd  .a  C  fa O  ft £ CU cu  So O  CQ  8 S «a  •a « s  £  cn  f-H  X  o C£  a  cu  -C5  o  - X3  -t->  2  2 o  cn  Cd  g>  —3  cj 60  a  cn •fa. X CU C H  •a ° _8 cd kn  3 < O  O r<  cs  a  o  Cu  cd Cd  DHQ  e £  W  o H  O  H  cu  cn  cn  cq x  o, > cu  T3  3 O  cu Cu 3  T3  cn  cu  -s; o  T3  00  a ,a aa o ^ cd cu  M  o H  H—  ©  ©  ©  ^  ~a o  "cu  o  Ci  Cu 3  OH  o  CU T3 X  a o  kH  o  cu  a  cd  Cu ~cu  ^ 'C  O H  G  S  rrt  PH  „  kH  *H  <«J cn ,_J  O  cn  £  1  cj  "o  o  >H 3  O % —  V  cu o  60 "3  cn  cu M  1/3  .-a  ^  PH  cn  cn  £ 5  cn  2  H-» cn  O  h  cu  cu  -4—»  K  fr cd  cn  CU cn  cd cu kH  CJ  a  CD  kn cn CD ^O cn !=> CU .eg  H_,  CJ cd  •+—»  a o o  X3  cu cn cd cu kH  o a  r a >N Cu  cn r3  ,cd  00 :  18 3  cn  .>H  cd  H cu  X  o  cn CD 00 CD  X  U  X  "© U  Experiences of Interventionists 83  (d) Teaching strategies/therapy - this subcategory included comments about the need for training in Natural Teaching Strategies (NTS), discrete trial teaching, and various other types of therapy (e.g., play therapy). (e) Organizational structure/policy/philosophy - comments in this subcategory pertained to receiving training on how the employing organization was structured and operated, including information on organizational policies, procedures, and philosophy. (f) Reading materials/current research/best practice - this subcategory pertained to the need for more information on best practice and current research, as well as increased access to reading materials. (g) Activity/program ideas - comments in this subcategory pertained to a need for strategies for making programs fun and interesting for the child, and a need for ideas for new activities or programs. (h) Data keeping/collection - this subcategory included comments about the need for more training and information on how to take data and fill out data sheets correctly. (i) Other job training - this subcategory included any quotations referring to a need for review of training reviews or increased training in general. It also included quotations about specific kinds of training that did not belong in one of the above categories. For example, the quotation "computer training so I can be more independent with compiling materials" was included here. (j) General workshops - this subcategory included any general quotations referring to a need for increased workshops, conferences, in-services, professional development, and that did not refer to specific kinds of workshops.  Experiences of Interventionists 84  Quotations in the category of Increased Supervision and Support referred to a desire for increased input from senior staff members, including feedback about job performance, regular communication, increased team meetings, video reviews, and coaching or "hands on" training from experienced staff. Quotations in the Increased Contact with Other Bis category referred to a desire for increased opportunities to observe or work with other Bis. Participants indicated that both watching other coworkers with children and being observed working by other coworkers was beneficial because it provided them with new ideas for programs, and it also gave them an opportunity to give and receive feedback on their work. Some participants wrote about wanting more social contact and interaction with other Bis, to counteract the isolated nature of their work. Quotations in the Family/Parent Support category referred to wanting more training or support on how to deal with families, Or wanting more training or support for the families themselves. Some Bis wrote about wanting more workshops on how to handle situations that might arise while working in the home, or how to approach parents when dealing with difficult issues. Some Bis indicated that support groups or increased training for parents would be beneficial. The Job/Work Environment category contained quotations about changing aspects of the job or work environment, including an increase in pay, paid training time, flexible training hours, and more time in general to accomplish work tasks. Finally, a category of "Other/don't know" was used to include quotations that were either too vague to categorize accurately or that did not belong in any of the above five categories. For example, the quotation "consistency in paperwork" was placed in this subcategory. Table 17  Experiences  of Interventionists  provides a representative sample of quotations from participants for each of the categories and subcategories in Question #3.  85  Experiences of Interventionists 86  cu  c o uo +H c _o CO CO  cr c '5 o <£ O  c CD  cn cu i- ,  o  cd cu  J£ 60  _E  00  c  CU  o «  e o Q .  3 cn ^  _o '« '> u  CU C L  o PH  i  £  cu > cu  cn T3 O  53  CU  r"  cu  ... o %—» X IS CO t  8?  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A number of variables were examined, including stress, strain, and coping; characteristics of children with ASD and their families; most and least rewarding aspects of the job; and training and support needs. Both quantitative and qualitative research methodologies were utilized with the aim of providing a comprehensive and in-depth analysis of Bis' experiences. Based on the results of these analyses, conclusions were drawn and the implications of the findings will be discussed below, beginning with a discussion of BI's occupational work roles. Work Roles  As measured by the OSI-R (Osipow, 1998), the two work roles of Role Overload (RO) and Role Boundary (RB) were rated by Bis as significantly more stressful than the other four OSI-R work roles (Role Ambiguity, Role Insufficiency, Responsibility, and Physical Environment). According to Osipow (1998), people who score high on RO "may describe their work load as increasing, unreasonable, and unsupported by needed resources. They may describe themselves as not feeling well trained or competent for the job at hand, needing more help, and/or working under tight deadlines" (p. 12). That this was the case for many Bis was supported by their responses to the open-ended question about the most challenging or stressful aspects of their jobs. A number of the statements in the ORQ were repeated in participants' responses. For example, one of the ORQ statements, "I have to take work home with me" was echoed by a number of participants. The finding that lack of time and work overload were sources of stress is  Experiences of Interventionists 88  consistent with previous research on home visiting in general (Moore & Katz, 1996; Stewart & Arklie, 1994; West & Savage, 1988). In addition, it appeared that many Bis did not feel adequately trained for their work. For example, Participant 3 wrote, "Considering I had very little training, I would have liked to have [had] a more structured training plan set out. I was given a binder and a few double-ups and then was on my own. It was very stressful!" Previous studies that have examined the experiences of home visitors also found that lack of training was a source of stress (Appleby, 1987; McBride & Peterson, 1997). Almost all Bis described a need for training in several areas ranging from more "hands on" support from senior staff to learning more SLP techniques to learning how to manage parent/family issues more effectively. The finding that participants felt that they needed more training in a number of important areas related to their work provided further validation to the finding that Role Overload was one of the two most stressful work roles. The other work role found to be significantly more stressful was Role Boundary (RB). According to Osipow (1998), people who score high on RB "may report feeling caught between conflicting supervisory demands and factions. They may report not feeling proud of what they do, or not having a stake in the enterprise. They also may report being unclear about authority lines and having more than one person telling them what to do" (p. 12). Again, the findings of the ORQ were supported by participants' responses to the open-ended question about stressors. Many Bis described the stress of trying to meet the expectation of various team members and of struggling to incorporate the goals and interests of all stakeholders. For example, Participant 36 talked about "receiving conflicting messages from supervisors and staff on how to do things." Participant 5 wrote that it was stressful "dealing with many supervisors." Bis not only struggled to meet the needs of supervisors and senior staff members, but family members as well. For  Experiences of Interventionists 89  example, Participant 18 wrote that it was challenging "deciding whether to fulfill what my supervisor wants done or what the parents want done, when the two are often conflicting." Again, a number of ORQ items, such as "I have more than one person telling me what to do, "I have divided loyalties on my job," and "My supervisors have conflicting ideas about what I should be doing" were echoed in participant's written responses. Thus, the issue of conflict, inconsistency and/or lack of support between Bis and other team members was evident in both their Role Boundary scores and their responses to the question about stressors. Previous research has also shown that conflict with other professionals or work colleagues is a source of stress for home visitors (Stewart & Arklie, 1994; West & Savage, 1988). Although Role Ambiguity (RA) was the third highest mean, it was significantly lower than either RO or RB. This was contrary to the hypothesis that RO, RB, and RA would all be higher than the other three work role scores of Role Insufficiency (RI), Responsibility (R), and Physical Environment (PE). Given that high RA scores refer to having unclear expectations about the job and receiving inadequate job evaluation/feedback, it is somewhat surprising that this was the case. A number of participants described receiving little or no feedback from their supervisors about their job performance. For example, Participant 37 wanted "regular evaluations by qualified, knowledgeable staff," and "regular feedback, whether it be constructive criticism or positive reinforcement." Similar sentiments were echoed by a number of other respondents. The finding that role ambiguity is a source of stress has also been documented in previous literature on home visitors (Appleby, 1987; Goodwin, 1983; Stewart & Arklie, 1994). The remaining three work roles, Role Insufficiency (RI), Physical Environment (PE), and Responsibility (R) were expected to have lower scores, because they were not work roles likely to be associated with stress for Bis. RI pertains to feeling bored with or overqualified for a job,  Experiences of Interventionists 90  feeling that there is a poor fit between one's skills and one's job, and experiencing little workrelated recognition or success. Although some aspects of RI were not expressed by any of the Bis in response to the question about stressors (e.g., feeling bored or overqualified), a few did mention a lack of recognition for their work. This may explain why RI was the fourth highest score, because some Bis would have endorsed the statements in this subscale. Physical Environment (PE), which refers to being exposed to high levels of noise, moisture, dust, heat, cold, light, or unpleasant odours, was the next highest score. The vast majority of Bis did not report that the physical environments in which they worked were a significant concern. Finally, R referred to having high levels of responsibility for the activities and work performance of subordinates, being sought out for leadership, and having to make important decisions. Given that Bis work under the supervision of others and are typically told by others how to do their jobs, it is not surprising that this work role had the lowest score. Overall, the ORQ results were found to be very consistent with BI's qualitative accounts of job-related stress as well as with previous research on the stressors faced by home visitors in general. ORQ and Family Environment Scale Correlations  No statistically significant correlations were found between ORQ scores and any of the 10 subscale scores on the Family Environment Scale (FES). The only correlation that approached significance was between ORQ scores and the Active-Recreational Orientation (ARO) subscale (r = -.24,p = .07). ARO pertains to the family's participation in social and recreational activities and contains statements such as "family members spend most weekends and evenings at home," "friends often come over for dinner or to visit the family," and "family members go out a lot." Interestingly, the correlation was negative, indicating that higher levels of stress were related to  Experiences of Interventionists 91  lower levels of active-recreational orientation and vice versa. However, given that this was not a significant correlation, no conclusions can be made about this suggestive finding. The FES was used to measure aspects of the family environment, in order to determine which characteristics of challenging families were associated with higher levels of BI stress. However, no significant correlations were found, suggesting that either: (a) no specific characteristics of families as measured by the FES were related to BI stress, or (b) the FES did not adequately reflect the characteristics of challenging families that were associated with BI stress. Given that many Bis wrote about family-related stressors in their qualitative responses, the former possibility does not seem likely. Indeed, when examining participants' responses regarding stressful or challenging family variables, a different set of variables than those reflected on the FES emerged. Many participants wrote about the stress of working in a family's home and being exposed to private, overly personal information about the family. Bis found it difficult to try and maintain professional boundaries with families, so as not to become personally involved in families' lives. For example, Participant 3 wrote that "entering into a family's private space" was challenging, because it entailed "dealing not only with what is going on with your child but their entire family." This finding, that maintaining a balance between professionalism and genuine concern for families is difficult, is supported by previous research on home visitors (Goodwin, 1983; Russell, 1981; Wasik & Bryant, 2001). The second family issue mentioned by Bis was conflict/inconsistency/lack of support between themselves and family members. Some Bis wrote about experiencing a lack of communication with families, feeling that they were not valued or appreciated by families, experiencing conflict with family members regarding how to support a child, and feeling that families did not follow through with intervention goals. For example, Participant 27 described "feeling conflicts about what you were  Experiences of Interventionists 92  taught and believe is right to do and parent's opinion/behaviour." Finally, the third family category was family expectations, and referred to parents expecting their child to improve quickly or having what Bis believed to be unrealistically high expectations. For example, Participant 15 wrote about a family "expecting the child to get better, which does not happen so quickly, then suggesting it's me not doing my job." Although the FES is a well researched and psychometrically sound instrument for assessing family environment that has been in use for over 20 years, it did not appear to be a sufficiently sensitive tool for measuring Bis' experiences with families. The FES was designed to measure a wide range of variables that pertain to the family environment, yet few of the variables identified by respondents in the open-ended question about stressors were included in the FES subscales. While the FES did measure variables pertaining to relationships between family members (e.g., conflict, expressiveness, independence), it did not measure variables pertaining to relationships between home visitors such as Bis and the family. Yet, it was  precisely the latter relationship that was described by Bis as being stressful. Thus, although some of the FES subscales were expected to relate directly to Bis' experiences with families (e.g., cohesion), they appeared to measure a different type of relationship than that experienced by Bis and family members. This probably occurred because Bis are visitors to households rather than integral, functioning members of the families with whom they work. ORQ and Autism Behavior Checklist Correlations  Significant positive correlations were found between ORQ total scores and the Autism Behavior Checklist (ABC) subscale scores that measured Relating and Sensory behaviors. Again, the information provided by participants in response to the questions about stressors and rewards supports these correlations. The Relating subscale pertains to the child's social  Experiences of Interventionists 93  relatedness to other people, and includes statements such as "has no social smile," "is not responsive to other people's facial expressions/feelings," "actively avoids eye contact," and "looks through people." One of the most rewarding child subcategories described by participants pertained to establishing a relationship or connection with the child. For example, Participant 39 wrote about the reward of "having the child return eye contact, a smile." Another respondent described the joy of "knowing that the child enjoys spending time with me" (Participant 18). Clearly, establishing a relationship or connections with the children with whom they worked was very important to the Bis. Thus, it follows that higher levels of stress would be associated with higher levels of child un-relatedness. A significant correlation was also found between total ORQ scores and the Sensory subscale scores on the ABC. This statistical relationship was not as explicitly reflected in Bis' responses to the open-ended questions. The Sensory subscale refers to sensory-related behaviours of the child and contains statements such as "poor use of visual discrimination when learning," "seems not to hear," "covers ears at many sounds," and "stares into space for long periods of time." It may be that some of these sensory-related behaviours are associated with difficulty engaging/motivating a child or with a child's lack of progress, both of which were child-related stressors listed by many Bis. For example, Participant 48 wrote about the difficulty of "finding ways to engage the child when they are being detached/uninterested/ unfocussed." Participant 65 described the "stress related to lack of progression in skills." It may be that some of the sensory issues experienced by children with autism affect their ability to learn or engage with Bis during intervention. Thus, a child who seems not to hear or who stares into space may not make much progress and may be difficult to engage or motivate. It should be noted that only 7% of the variance in the relation between ORS scores and ABC Sensory scores could be  Experiences of Interventionists 94  explained; thus, there are clearly other variables involved in the complex relationship between BI stress and a child's sensory behaviours that were not accounted for in this study. The next strongest correlation (and one that was close to significance, r = .23,p = .07) was between total ORQ scores and Body and Object Use subscale scores. The Body and Object Use subscale pertains to unusual behaviours, unusual interactions with the environment, and unusual use of physical objects by the child. Some of the statements from this subscale include "insists on keeping certain objects with him/her;" "does not use toys appropriately;" and "will feel, smell, and/or taste objects in the environment." The majority of items in the subscale were not listed by Bis as child-related stressors, which may explain why this correlation did not reach significance. The next strongest correlation was between total ORQ scores and Social and Self Help subscale scores (r = .19, p - .13). The subscale includes statements such as "difficulties with toilet training," "does not wait for needs to be met (wants things immediately);" and "does not dress self without frequent help." Given that Bis did not describe a child's lack of social and self help skills as challenging for them to deal with in their work, it is not surprising that this correlation was not significant. As has been noted previously, a number of Bis listed children's challenging behaviours as being very stressful. For example, Participant 43 wrote, "challenging behaviour/tantrums .. .make you sweat!" Another respondent described the challenge of "remaining neutral when being physically hit/kicked" (Participant 48). Unfortunately, only a few of these challenging behaviours are represented in the ABC, and are distributed across two different subscales, Body and Object Use, and Social and Self Help. The number of items referring to problem behaviour in the Body and Object Use subscale is 6 out of 12 (50%). However, only 2 of the 6 items (i.e.,  Experiences of Interventionists 95  17% of the entire subscale) describe behaviours that were noted by the Bis as being stressful (e.g., self injury). For the Social and Self Help subscale, 4 out of the 11 items pertain to problem behaviour (36%); of those 4, only 2 items (i.e., 18% of the entire subscale) refer to behaviours mentioned by Bis as stressful (e.g., severe tantrums). Thus, it may have been that endorsing these few items was not enough to produce a higher (and perhaps significant) score for these particular subscales. Furthermore, because the problem behaviour items are distributed between two subscales on the ABC, they may have had less of an impact on the total scores for these subscales (i.e., produced lower scores) than would have occurred had they been contained in one subscale only. The weakest correlation was between total ORQ scores and Language subscale scores (r = A3,p=  .29). The Language subscale pertains to the child's language and communication  skills, and contains statements such as, "does not follow simple commands given once," "gets desired objects by gesturing," "echoes questions or statements made by others," and "cannot point to more than five named objects." Given BI's qualitative responses, it is somewhat surprising that a stronger correlation was not found between stress and children's language abilities. A number of Bis wrote that they wanted more support from speech-language pathologists (SLPs) and more training in SLP issues. For example, Participant 54 wrote, "I strongly believe that more support from.. .SLPs is necessary to provide more effective intervention to the children. They need to come in and work with the children more often." Participant 49 commented, "I would greatly appreciate training around expanding language." Given that more training in speech and language issues was a significant need for many Bis, a stronger relationship between BI stress and the child's language abilities might have been expected.  Experiences of Interventionists 96  The Relation Among Stress, Strain, and Coping  In the Stress, Strain and Coping (SSC) model proposed by Osipow and Davis (1988) and described in Chapter 1, occupational stress is seen as having a significant consequence—namely psychological strain—that can affect an individual's work performance. Thus, psychological strain is conceptualized as the negative outcome of work stress. However, the SSC model predicts that "where perceived occupational stressors are equal for two people, differences in coping resources would serve to moderate the resulting strain" (Osipow & Davis, 1988, p. 2). Thus, high occupational stress does not by itself result in psychological strain; rather, an individual's coping resources must be accounted for in order to predict the degree of strain experienced. Coping skills are critical to this model because they mitigate the individual's experience of stress. The relation among Bis' stress, strain, and coping was examined empirically. In the linear regression, stress (ORQ) scores were found to be significantly positively related to strain (PSQ) scores, meaning that higher levels of stress were associated with higher levels of strain. A significant negative relation was also found between coping (PRQ) scores and strain (PSQ) scores, indicating that higher levels of coping were associated with lower levels of strain, and vice versa. These findings were consistent with Osipow's theory (1998). However, coping was not found to have a significant moderating effect on the relationship between stress and strain. This finding is contrary to what was predicted based on the SSC model of Osipow and Davis (1988). However, in their classic article on moderator and mediator variables, Baron and Kenny (1986) provided what may be an explanation for the finding that coping did not appear to moderate the stress-strain relationship for Bis. They noted that "it is desirable that the moderator variable be uncorrelated with [italics added] both the predictor and the criterion (the dependent  Experiences of Interventionists 97  variable) to provide a clearly interpretable interaction term" (p. 1174). However, significant correlations were found both between coping and stress (r = -.39, p = .002), and coping and strain (r = -.60, p < .0001). These correlations may explain why coping did not have a significant moderating effect on the relationship between stress and strain. Although coping was not found to have a significant moderating effect, the correlations between coping and stress and coping and strain are significant and deserve further discussion. In particular, the strong negative relation between coping and strain indicates that coping is an important component of a person's experience of psychological strain—36% of the variance in coping was associated with the variance in strain. Thus, a person's coping resources play an important role in his/her experience of strain. Limitations of the Study  Variability among groups. The 65 participants were recruited from six different sites located in two provinces. Thus, they represented six unique groups of participants. Although the organizations all provided similar forms of intensive behavioural intervention, the exact interventions varied across sites and also likely varied somewhat within a site, given that different Bis provide the intervention. For example, some organizations provided more discrete trial teaching (DTT), and others maintained more of a balance between DTT and play-based therapy. As one might expect, the sites also varied with respect to variables such as the number of hours of one-to-one intervention provided to children per week, the amount and types of initial and ongoing staff training, and the number of Bis who consented to participate in the study. It should be emphasized, however, that significant differences between sites were only found for two demographic variables, hours of work per week and education, and that these differences were statistically determined not to be related to the outcome measures (see Chapter 3).  Experiences  of Interventionists  98  Although such variability likely represents the diversity of sites within the population and therefore suggests that the results may be broadly applicable, one must be cautious with regard to the generalizations that can be made from the study's sample. Furthermore, Bis in the study were employed by organizations and did not work privately for families. Thus, the results cannot be readily extended to those Bis who are employed by families directly. Training information. A second limitation of the study regards the training information gathered from participants via the demographic sheet. Participants had to recall information about specific hours of initial training and ongoing training provided by the employing organization. Many participants noted that trying to recall the number of hours of initial training they received was a challenge, especially if they had been employed by the agency for an extended period of time. For example, one participant reported receiving 7.25 hours of training in the area of attending workshops when he/she was first hired over one year ago. However, it is unlikely that the precise number of 7.25 was an accurate estimation of the training hours that the participant received. The amount of general types of training (e.g., "hands on" training provided by staff when first hired) is even less likely to be recalled accurately. Thus, it is probable that the training information provided by a number of participants in the study was at least somewhat unreliable. Training variability. There was considerable variability across sites with regard to the amount of initial, ongoing, and total training that Bis received, and thus, the group was less homogenous. However, no statistically significant correlations were found between training and any of the outcome measures (i.e., stress, strain, and coping), indicating that the amount of training that Bis received was not related to their levels of stress, strain, and coping.  Experiences of Interventionists 99  Family Environment Scale (FES).  The FES was originally intended for family members  to provide a picture of their own family environment. However, as ex ained in Chapter 2, the FES was adapted for the purposes of this study, to enable Bis to give their impressions of the challenging families with whom they worked. As noted previously, the FES did not appear to reflect the experiences of Bis in family homes adequately. In addition, the adaptation of the FES may have also contributed to its apparent lack of utility for this group of participants. Given these issues, the lack of findings regarding the FES subscales should not be construed as meaning that none exist. In addition, Bis were asked to characterize the most challenging or difficult families with whom they worked. Given that only one "extreme" of the family continuum was sampled (i.e., the most challenging families) the findings may not be generalizable to all families. It does seem likely however, that at least some of the family characteristics described by Bis as being challenging are also embodied by those families who are considered to be less challenging. For example, it seems reasonable to expect that certain issues such as working in a family's private living space or trying to maintain professional boundaries with families would be applicable to all families. Thus, the difference between "challenging" and "not challenging" families may be a matter of degree rather than the presence or absence of certain characteristics. However, this issue deserves additional research. Implications of the Study  A number of implications can be derived directly from the qualitative responses provided by participants. Given that Job variables accounted for 38% of the total number of responses in the "most stressful" category, agencies employing Bis would be well advised to examine these variables and determine how their stressful effects can be mitigated or reduced. Although the Bis  Experiences of Interventionists\QQ  in this study were relatively well paid by their employing organizations and had reasonable job security, they still listed Job variables as the most stressful aspects of their work. Although changing some of the Job variables may not be economically feasible (e.g., providing Bis with more paid preparation time), finding ways to alleviate at least some of the job-related stressors would likely lead to increased job satisfaction, job loyalty, and quality of work, as well as less absenteeism. In particular, higher morale and increased job loyalty could mean less employee turnover, which would save money on training costs in the long term. Related to job stressors is the issue of additional training and support for Bis. Bis listed various kinds of training and support that they believed would help them be more competent, skilled, and successful in their work. The finding that additional training was a significant need was further supported by the results of the ORQ, showing that Role Overload was one of the two most stressful work roles. Many Bis did not feel that they were adequately trained for their job and noted that they wanted to improve on previously learned skills and/or learn new skills. Providing more training in specific areas such as behaviour management, communication and language strategies, and data collection would address some of these issues. Providing Bis with strategies for dealing with "difficult" parents would help them to manage parent issues more independently, and might enable them to establish better working relationships with parents. Bis would also benefit from training on how to maintain professional boundaries with parents while working in the family home. More training and skill development might also reduce job-related stress, since Bis might feel more competent and confident in their work and their ability to do their jobs. In addition to training, a number of Bis expressed the need for increased support and feedback/evaluation from senior staff members as well as increased contact with other Bis.  Experiences of Interventionists\Q\  Clearly, many of the Bis in this sample felt isolated in their work and wanted increased support from team members. This support could come in a variety of forms, including "hands on" training, video reviews, written or verbal evaluations, increased meetings, and increased social (or tangible) reinforcement for doing a difficult job well. The significant role of coping resources in relation to both stress and strain also suggests other possibilities for the effects of coping. For example, although correlations are not causal relations, it may be that those Bis with more highly developed coping resources had a different experience of their "stressful" families. Bis with higher levels of coping resources might not have experienced the families with whom they worked to be as stressful or challenging as those Bis with lower levels of coping resources. Future Research  As noted in Chapter 1, there is currently no published research on the experiences of Bis who work in family homes with children with autism. Given this void, a multitude of possibilities exists for future research and additional variables of interest. On the basis of this particular study, several specific recommendations can be made in this regard. First, as noted previously, the Bis who participated in this study were all employed by organizations. Future research is needed to investigate the same variables with Bis who work privately for families to address questions such as: Are there differences between Bis who work privately versus Bis who work for organizations with respect to variables such as work-related stress, strain, and coping? Do Bis have different perceptions of the family and child when they are privately employed by the family? How does the relationship between the BI and family change as a result of having the child's parents as employers?  Experiences of Interventionists \ 02  Second, future research should attempt to examine the effects of various types of training and support on variables such as work-related stress and Bis' perceptions of the families and children with whom they work. Bis could be measured with regard to these variables (using, perhaps, the adapted OSI-R, which was quite helpful in the present study) prior to, and after receiving training. The effects of specific types of training could be targeted either within or across studies (e.g., watching training videos versus receiving "hands on" training). Given the large volume of BI responses pertaining to specific training and support needs, this is a significant area of research with many possibilities. Third, as noted in the previous section, the role of coping resources should be further examined, to determine its relationship to other variables such as the characteristics of challenging families. In addition, the ORQ measured four different types of coping resources— recreation, self care, social support, and rational/cognitive coping. Future research could examine which kinds of coping are most frequently used by Bis, and which kinds of coping are associated with the lowest levels of BI stress. Finally, information on the relationship among stress, strain, and coping could be used to develop a profile of a BI who is "most likely to succeed" in this area of work. The information could help to answer the following questions: What types of coping resources are utilized by Bis with the lowest levels of stress and strain? Are there commonalities between Bis with the lowest (or highest) levels of occupational stress? Do Bis with higher levels of coping have different experiences of the children and families with whom they work? This information could be very valuable to organizations in deciding who to hire and train as Bis. Conclusion  Experiences of Interventionists\Q2  This study has amended the shortcomings of previous research in a number of ways. It improved upon earlier studies that examined stress in HVs by utilizing a theoretical framework to explain the relation among stress, strain, and coping. Also, in contrast to a number of earlier studies, the definition of stress was operationalized and measured using a standardized instrument, which allowed for a more accurate and reliable examination of stress. Furthermore, the marriage of quantitative and qualitative research methods provided a much more comprehensive and rich data set on Bis' work experiences. Not only has this study contributed important information both to the literature on home visiting and to theoretical conceptualizations of occupational stress, but it has helped elevate research in these areas to a new conceptual and empirical level. At a minimum, the results of this study have a number of important implications for the education, training, and support of Bis who work for organizations in British Columbia and Alberta to provide intensive intervention to children with autism. This specific information is absent from the current literature, even though Bis are key members of teams providing support to children with ASD. They are the front-line support workers who work intensively for a number of hours weekly with individual children in family homes. They are the people who are ultimately responsible for guiding and moving children's programs forward. Researchers, clinicians, and administrators all need a better understanding of Bis' experiences—from Bis' perspectives—so that this information can be used to develop appropriate training programs and support networks that enable Bis to achieve success in the context of an extremely complex and challenging job. In the end, this information is likely to benefit not only Bis, but also the children and families who will be supported by more competent, knowledgeable, satisfied service providers.  Experiences  of Interventionists  \ 04  References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders  (4th ed.), text revision. Washington, DC: Author. Appleby, F.M. (1987). Stress in the first year of health visiting practice. Health Visitor, 60, 3940. Autism Society of British Columbia. Interim Early Intensive Funding Option: Qualified Service Providers, (n.d.). Retrieved September 8, 2003, from http://www.autismbc.ca Ballard, R. (1982). 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Dunlap (Eds.), Positive behavioral support: Including people with difficult behavior in the community (pp. 31-  50). Baltimore: Paul H. Brookes.  Experiences  of  Interventionists\05  Ehlers, S., & Gillberg, C. (1993). The epidemiology of Asperger syndrome: A total population study. Journal of Child Psychology and Psychiatry, 34, 1327-1350. Elfert, M . (2002). The essence of being a behavioural interventionist: A phenomenological study.  Unpublished manuscript, University of British Columbia, Vancouver, Canada. Evans, A. N . (1992). Using basic statistics in the behavioral sciences. Scarborough, Ontario:  Prentice-Hall Canada. Fletcher, B., Jones, F., & McGregor-Cheers, J. (1991). The stressors and strains of health visiting: Demands, supports, constraints, and psychological health. Journal ofAdvanced Nursing, 16, 1078-1089. French, J. R. P., Jr., Caplan, R. D., & Harrison, R. V. (1982). The mechanisms of job stress and strain. New York: John Wiley and Sons. Goodwin, S. (1983). Part 1: The stresses of health visiting. Health Visitor, 56, 20-21. Greenberg, S. F. (1980). Stress and the helping professions. Baltimore: Paul H. Brookes. Guglielmi, R. S., & Tatrow, K. (1998). Occupational stress, burnout, and health in teachers: A methodological and theoretical analysis. Review of Educational Research, 68, 61-99. Huck, S. W. (2000). Reading statistics and research. New York: Addison Wesley Longman. Karasek, R. A., & Theorell, T. (1990). Healthy work: Stress, productivity, and the reconstruction  of working life. New York: Basic Books. Kohler, F. W. (1999). Examining the services received by young children with autism and their families: A survey of parent responses. Focus on Autism & Other Developmental Disabilities, 14,150-8.  Experiences  of Interventionists  \ 06  Krug, D. A., Arick, J. R., & Almond, P. J. (1993). Autism screening instrument for educational planning: An assessment and educational planning system for autism and developmental  disabilities (2nd ed.). Austin, TX: PRO-ED.  Lazarus, R. S. (1981). The stress and coping paradigm. In C. Eisdorfer, D. Cohen, A. Kleinman, & P. Maxim (Eds.), Models for clinical psychopathology (pp. 177-214). New York:  Spectrum Medical & Scientific Books. Leaf, R., & McEachin, J. (1999). A work in progress: Behavior management strategies and a curriculum for intensive behavioral treatment of autism. New York: DRL Books. Lovaas, O. I. (1981). Teaching developmentally disabled children: The ME book. Austin, TX:  Pro-Ed. Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.  Lovaas, O. I. (1996). The UCLA young autism model of service delivery. In C. Maurice (Ed.), Behavioral intervention for young children with autism (pp. 241-248). Austin, TX: PRO-  Ed. Maurice, C. (1993). Let me hear your voice: A family's triumph over autism. New York:  Ballantine Books. McBride, S. L., & Peterson, C. (1997). Home-based early intervention with families of children with disabilities: Who is doing what? Topics in Early Childhood Special Education, 17,  209-234. Moore, S., & Katz, B. (1996). Home health nurses: Stress, self-esteem, social intimacy, and job satisfaction. Home Healthcare Nurse, 14, 963-969.  Experiences of Interventionists 107  Moos, R. H., & Moos, B. S. (1994). Family environment scale manual: Development,  applications, research (3rd ed.). Palo Alto, CA: Consulting Psychologists Press. Neuendorf, K. A. (2002). The content analysis guidebook. Thousand Oaks, CA: Sage Publications. Osipow, S. H. (1998). Occupational stress inventory revised edition: Professional manual.  Odessa, FL: Psychological Assessment Resources. Osipow, S. H., & Spokane, A. R. (1984). Measuring occupational stress, strain, and coping. In S. Oskamp (Ed.), Applied social psychology annual: Applications in organizational settings  (pp. 67-86). Beverly Hills, CA: Sage Publications. Osipow, S. H., & Davis, A. S. (1988). The relationship of coping resources to occupational stress and strain. Journal of Vocational Behavior, 32, 1-15.  Prizant, B. M., & Wetherby, A. M. (1998). Understanding the continuum of discrete-trial traditional behavioral to social-pragmatic developmental approaches in communication enhancement for young children with autism/PDD. Seminars in Speech and Language, 19, 329-353. Robinson, J. (1983). The role dilemma of health visiting. Health Visitor, 56, 22-24. Rout, U. (2000). Stress amongst district nurses: A preliminary investigation. Journal of Clinical Nursing, 9, 303-309. Russell, P. (1981). Helping parents of handicapped children—the health visitor's role. Health Visitor, 54, 472-475. Scott, J. (1996). Recruiting, selecting, and training teaching assistants. In C. Maurice (Ed.), Behavioral intervention for young children with autism (pp. 231-240). Austin, TX: PRO-  Ed.  Experiences  of  Interventionists\Q%  Smith, T. (2001). Discrete trial training in the treatment of autism. Focus on Autism & Other Developmental Disabilities, 16, 86-92.  Snelgrove, S.R. (1998). Occupational stress and job satisfaction: A comparative study of health visitors, district nurses, and community psychiatric nurses. Journal of Nursing Management, 6, 97-104. Stewart, M.. J., & Arklie, M. (1994). Work satisfaction, stressors and support experienced by community health nurses. Canadian Journal of Public Health, 85, 180-183. Towbin, K. E. (1997). Pervasive development disorder not otherwise specified. In D. J. Cohen & F. R. Volkmar (Eds.), Handbook of autism and pervasive developmental disorders (pp.  123-147). New York: Wiley. Wasik, B., & Bryant, D. M . (2001). Home visiting: Procedures for helping families (2nd ed.).  Thousand Oaks, CA: Sage Publications. West, M . A., & Savage, Y. (1988). Stress-in health visiting: Qualitative accounts. Health Visitor, 61, 305-308. West, M . A., Jones, A., & Savage, Y. (1988). Stress in health visiting: A quantitative assessment. Health Visitor, 61, 269-271.  Whiteford Erba, H. (2000). Early intervention programs for children with autism: Conceptual frameworks for implementation. American Journal of Orthopsychiatry, 70, 82-94. Wilson, J. (1996). A parent's introduction to "behavior modification. " Unpublished manuscript, Delta Association for Child Development, Delta, British Columbia, Canada.  Experiences  of Interventionists\§<)  Appendix A Feedback Form for Pilot Study Questionnaire name:  Were the instructions clear and easy to understand? (please circle one) • If you answered NO, please elaborate  YES  NO  Were the questions/statements clear and easy to understand? (please circle one) YES NO • If you answered NO, please elaborate  How did you feel as you completed the questionnaire? Did you have any particular reactions or thoughts?  Did you feel any discomfort or reservations about answering any of the questions/statements? (please circle one) YES NO •  If you answered YES, please elaborate  Is there anything you feel should be modified/revised/changed with respect to this questionnaire?  Experiences oflnterventionists\ 10  Appendix B Occupational Stress Inventory Revised (OSI-R)  OSI-R Item Booklet  This booklet is divided into three sections which contain statements about work situations and individual habits. You may be asked to complete one, two, or all three of the sections. Be sure to respond to all of the statements for each section you are asked to complete. Begin by completing the information on the front page of your OSI-R Rating Sheet. Enter your name, age, gender, job title, and today's date. Now turn to page 3 for directions for completing your ratings.  R4R  Psychological Assessment Resources, Inc./P.O. Box 998/Odessa, FL 33556/Toll-Free 1-800-331-TEST/hlt|)://www.|>Hrinc..r.om  Copyright © 1981, 1983, 1987. 1998 by Psychological Assessment Resources, Inc. All rights reserved. May not be reproduced in whole or in part in any form or by any m e a n s without written permission of Psychological Assessment Resources, Inc. This booklet is printed in green ink on white paper. Any other version is unauthorized. 9 876 54  Reorder #RO-4072  Printed in the U.S.A.  Experiences of Interventionists \ \ \  Directions Read each statement carefully. For each statement, fill in the circle with the number which fits you best. Fill in © if the statement is rarely or never true. Fill in @ if the statement is occasionally true. Fill in @ if the statement is often true. Fill in 0 if the statement is usually true. Fill in © if the statement is true most of the time. For example, if you believe that a statement is often true about you, you would fill in the 3 circle for that statement on your rating sheet. Example 1 © © • © © Fill in only one circle for each statement. Be sure to rate A L L of the statements for each section you are asked to complete. D O N O T ERASE! If you need to change an answer, make an " X " through the incorrect response and then fill in the correct circle, like this. Example  If a statement is not applicable, please mark © rarely or never true.  In addition to the above instructions, please read the definitions provided below for some of the terms used in this booklet. The term " S U P E R V I S O R " refers to your immediate supervisor; the person who supervises you at work and provides you with feedback about your performance. This person may not have the actual title of "supervisor," but s/he immediately oversees your work. The terms " B O S S " and " E M P L O Y E R " both refer to the ultimate authority in the organization (i.e., the person(s) considered " i n charge" of all employees in the workplace). When answering questions about working with people from other work " D E P A R T M E N T S , UNITS, and/or A R E A S , " the questions are referring to working with other team members in your organization (e.g., a Speech-Language Pathologist). P L E A S E C O M P L E T E A L L T H R E E S E C T I O N S OF THIS B O O K L E T .  Experiences of Interventionists\ 12  SegipOne (ORQ) Make your ratings in Section One of the Rating Sheet 1. At work I am expected to do too many different tasks in too little time.  21  My supervisor provides me with useful feedback about my performance.  2. I feel that my job responsibilities are increasing.  22.  It is clear to me what I have to do to get ahead.  3. I am expected to perform tasks on my job for which I have never been trained.  23. I am uncertain about what I am supposed to accomplish in my work.  4. I have to take work home with me.  24.  When faced with several tasks I know which should be done first.  25.  I know where to begin a new project when it is assigned to me.  5. I have the resources I need to get my job done. 6. I'm good at my job. 7. I work under tight time deadlines.  26. My supervisor asks for one thing, but really wants another.  8. I wish that I had more help to deal with the demands placed upon me at work.  27.  9. My job requires me to work in several equally important areas at once. 10. I am expected to do more work than is reasonable.  I understand what is acceptable personal behavior on my job (e.g., dress, interpersonal relations, etc.)  28. The priorities of my job are clear to me. 29. I have a clear understanding of how my boss wants me to spend my time.  11. My career is progressing about as I hoped it  30.  would. 12. My job fits my skills and interests.  I know the basis on which I am evaluated.  31. I feel conflict between what my employer expects me to do and what I think is right or proper.  13. I am bored with my job. 14. I feel I have enough responsibility on my job.  32. I feel caught between factions at work.  15. My talents are being used on my job.  33. I have more than one person telling me what to do.  16. My job has a good future. 17. I am able to satisfy my needs for success and recognition in my job.  34. I know where I fit in my organization.  18. I feel overqualified for my job.  35. I feel good about the work I do.  19. I learn new skills in my work.  36. My supervisors have conflicting ideas about what I should be doing.  20. I have to perform tasks that are beneath my ability.  37. My job requires working with individuals from several departments or work areas.  4  38.  It is clear who really runs things where I work.  39  I have divided loyalties on my job.  40  I frequently disagree with individuals from other work units or departments.  Experiences of Interventionists \ 13  41.  I deal with more people during the day than I prefer.  51. On my job I am exposed to high levels of noise. 52. On my job I am exposed to high levels of wetness.  42. I spend time concerned with the problems others at work bring lo me. 43.  53. On my job I am exposed to high levels of dust.  I am responsible for the welfare of subordinates.  44. People on-the-job look to me for leadership.  54. On my job I am exposed to temperature extremes.  45.  55. On my job I am exposed to bright light.  1 have on-the-job responsibility for the activities of others.  56. My job is physically dangerous.  46. 1 worry about whether the people who work for/with me will get things clone properly. 47. My job requires me to make important decisions. 48.  57.  1 have an erratic work schedule.  58.  1 work all by myself.  59. On my job I am exposed to unpleasant odors.  If I make a mistake in my work, the consequences for others can be pretty bad.  60. On my job I am exposed to poisonous substances.  49. I worry about meeting my job responsibilities. 50. I like the people I work with.  5  Experiences of Interventionists\ 14  S ^ p f T w o (PSQ) Make your ratings in Section Two of the Rating Sheet I'. I don't seem to be able to get much done at work.  21. I wish I had more time to spend with close friends.  2. Lately, I dread going to work.  22. I often quarrel with the person closest to me.  3. I am bored with my work.  23.  4. I find myself getting behind in my work, lately.  24. M y spouse and I are happy together.  5. I have accidents on the job of late. 6. The quality of my work is good.  25. Lately. I do things by myself instead of with other people.  7. Recently, 1 have been absent from work.  26.  8. 1 find my work interesting and/or exciting.  27. Lately, my relationships with people are good.  9. I can concentrate on the things I need to at work.  28. 1 find that I need time to myself to work out my problems.  10. I make errors or mistakes in my work.  I often argue with friends.  I quarrel with members of the family.  29. Lately, I am worried about how others at work view me.  11. Lately, I am easily irritated.  30. I have been withdrawing from people lately.  12. Lately, I have been depressed. 13. Lately, I have been feeling anxious.  31. I have unplanned weight gains.  14. I have been happy, lately.  32. M y eating habits are erratic.  15. So many thoughts run through my head at night that I have trouble falling asleep.  33. I find myself drinking a lot lately. 34. Lately, I have been tired.  16. Lately, I respond badly in situations that normally wouldn't bother me.  35. I have been feeling tense.  17. I find myself complaining about little things.  36. I have trouble falling and staying asleep.  18. Lately, I have been worrying.  37. I have aches and pains I can not explain.  19. I have a good sense of humor.  38. I eat the wrong foods.  20. Things are going about as they should.  39. I feel well. 40. I have lots of energy lately.  6  Experiences of Interventionists\ \ 5  Secti0nTKree (PRQ) Make your ratings in Section Three of the Rating Sheet When I need a vacation I take one.  21. There is at least one person important to me who values me.  2. I am able to do what I want to do in my free time.  22. I have help with tasks around the house.  3. On weekends I spend time doing the things I enjoy most.  23.  4. I hardly ever watch television.  24. There is at least one sympathetic person with whom I can discuss my concerns.  5. A lot of my free time is spent attending performances (e.g., sporting events, theater, movies, concerts, etc.)  I have help with the important things that have to be done.  25. There is at least one sympathetic person with whom 1 can discuss my work problems.  6. I spend a lot of my free time in participant activities (e.g., sports, music, painting, woodworking, sewing, etc.)  26.  1 feel I have at least one good friend I can count on.  27. I feel loved.  7. I set aside time to do the things I really enjoy.  28. There is a person with whom I feel really close.  8. When I'm relaxing, I frequently think about work.  29.  I have a circle of friends who value me.  30. If I need help at work, I know who to approach.  9. I spend enough time in recreational activities to satisfy my needs. 10. I spend a lot of my free time on hobbies (e.g., collections of various kinds, etc.) 11. I am careful about my diet (e.g., eating regularly, moderately, and with good nutrition in mind.)  31.  I am able to put my job out of my mind when I go home.  32.  I feel that there are other jobs I could do besides my current one.  33. I periodically reexamine or reorganize my work style and schedule.  12. I get regular physical checkups. 13. I avoid excessive use of alcohol.  34. I can establish priorities for the use of my time.  14. I exercise regularly (at least 20 minutes, 3 times a week.)  35. Once they are set, I am able to stick to my priorities.  15. I practice "relaxation" techniques.  36. I have techniques to help avoid being distracted.  16. I get the sleep I need.  37. I can identify important elements of problems I encounter.  17. I avoid eating or drinking things I know are unhealthy (e.g., coffee, tea, cigarettes, etc.)  38. When faced with a problem I use a systematic approach.  18. I engage in meditation.  39. When faced with the need to make a decision I try to think through the consequences of choices I might make.  19. I practice deep breathing exercises a few minutes several times each day. 20. I floss my teeth regularly.  40. I try to keep aware of important ways I behave and things I do.  7  Experiences ofInterventionists \ lf5  Appendix C Family Environment Scale (FES) <  j i! D  £ o> o J -C O C >- ra j - >, £ o ~  o  CO  :,raroC <  _J  CD  2  \-  -J <  8  CD  o  ro  ro oo >> cu  c  c  CC  CD  E  oj 1=  £  £  — I  1  o  J3 ro  ro E >^ E  g  H CD  3  ro>>  o  Q. 00 CD  o  CD  2 2 E  CO  ro  £  X  °  2  r « ti H < ; a. E  0) c CD ^  •f T3 O c  5; ro '—  ro a;  j 8  o  ~u E J; o o CD oo c  QJ  ro  >  CD  m  ho_  Ee ra  c  2f ra  «j E  t3  =5 5  >, oo  c  ro  CD  "  > TJ O LL CD C cu ro  «™  E ro E 5. o 00 "O CD — <= -9 ro ro E ~ CD x: oo CD 00 — > ^ «5 £ E — o in O CD SZ) ro E £ E >. o 3 E Co E  ro CD  => o o r-  00 00 ^  £  I 'I £  o - ro C O 3 CD O CD CD — b= C>> ca 2, i . 9> 3 = — O •n P >3 o zzC00D % O > ~ J«C  O Q. C  . ^ -S g c 2 o n » i S  c  S  ro : .5 Q. O m —  S  o  ! 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O  CD  DO  wi  >-  CJ  n ' t ge  CJ  o  CL  ately  > . CD  SZ  E  C  >  DO O  US  „  O  _o  — CJ  c s 2?  mem . i n yo  >•  CD v_ CD  ur  O  c  r3  00.— 2 <> /  x>  elin  Q.  n> >  x:  '5  CD  CL  cu  3 O  Xi  O DO  CD t/1 >—  >-  0 —E u— JQJ D  rd 4— ^_  'Wor  .  0 >>~  an  C  s ±o  TJ CJ  3  o <D  3 O C  E  on  > « 50 c  QJ  £  •— QJ  > rd  —  raE O « Q. :  sz.E  rd O CL  E l/l QJ CU E — >•  _Q  ~  CO  U_  QJ JZ r-  r-'  00  E rd  QJ >  - E C  M—  n3 ,  3 O  in u  c:  o. 3 0.  Experiences of Iinterventionists \ \ J — — 'o szo  "EL  >—  O o o  O o  — 2 ~  >-  CJ  ra - H  CJ  £ >-  O U  O o  —  CD T3  r-  o -a  "a o  —  c  JD  p 5b  3  •  r!  cor;  —  o 'P > n  o .  o a  i  r-  l  l  -  ' O Q.—•- ~—  in .*Zl ra  -  tr: o  0 0  'p >..> o  O  X cj  -a  — '3  3  JTT  r-  —  :  §^ •£ E  o 5 x)  J=  o  •-  -  2  %  O Jr.  a. c o a.  1  -C"~  .= o  E =  CQ  Cn  o  £ ~  £  CJ  5: x  o  O  -D O  a un  £ tr  C  E a.  J-  i^l  DO  CJ C  — X> ™ c 5 LO E  r—  £  Q  o  ° • c  •—  5  r:  Q-  I CO  DO >.  ^<  C X O C  JD  o  QJ  X  o DO  C  §e E  o  "  o  t  c  J:  " o  •= °  F xi ^ 5 "  ra  _ >.  DO  is E ^ Cl c F ci C  E  CL  ±- ° •—  E  H3  CJ  -&  >-  ra  JD  c)  c  JD  CL  ° 3  ^  —  5  ra  S «> >- O ° Q..E  DO  S= • = 1: ci  > o  O  ci  E  Q  d  X  Z  CD  CD  >  O  —  -D  C CJ n3 CuO  >.  -C  E  cj  c  o  — I '  c  c  O  ISI  CJ  CL  o  o  E  — o u o o . DO " i  "3 c DO ra ' ~  J3  ra  £ —>- ci a u  o i/i  LA  >  o  b c X 1 — 2 O c a CL CJ c CJ  5  o  ra  D.  O  O  LUI  E x  > o — c: E ra  w ra  r-  —  iA0  7c O  O  in c  5  DO O  c  XI LO C ^  JZ  o ^ .  O JO  DO  E  JD  3  -* -cr  NO  _>-  _>-JZ  JD  ten  C-  cj ;  :  E g >.-£  " '  o  So. c DO ra sr. -<=  Fri din  .E  o  —  DO.E  C ...  1  it  •_  > • Nl  *J  Ct  p  ~ZZ  ra  mil ec ure  E  > c  ra  i  C O  icad  -  K o  CL  Ci. r- 3  00  o c  —  ra ro  JZ  Ge  ~  OJ  c  o >-  ra GJ ci X  Experiences of Interventionists} \ 8  Appendix D Modified Family Environment Scale (FES)  P L E A S E R E A D T H E S E INSTRUCTIONS S L O W L Y A N D C A R E F U L L Y B E F O R E C O M P L E T I N G THIS B O O K L E T Thank you!  F A M I L Y E N V I R O N M E N T S C A L E (FES)  Rudolf H. Moos INSTRUCTIONS  There are 90 statements in this booklet. They are statements about families. "Family" is defined as the immediate family members living together in the same house. You are to decide  which of these statements are true and which are false for the family that you selected at the beginning of the study. Make all your marks on the separate answer sheet. It is important that you answer all of the statements. If you think the statement is True or mostly True of the family, make an X in the box labeled T (True). If you think the statement is False or mostly False of the family, make an X in the box labeled F (False). It is important to answer each question as either True or False. If you are absolutely unable to label a statement either true or false, then make an X in the box labeled DK (Don't Know). Please use this category as sparingly as possible. You may feel that some of the statements are true for some family members and false for others. Mark T if the statement is True for most members. Mark F if the statement is False for most family members. If the members are evenly divided, decide what is the stronger overall impression and answer accordingly. Remember, we would like to know what the family seems like to you. So do not try to figure out how other members see the family, but do give us your general impression of the family for each statement. Your answers should reflect Y O U R perceptions of the family environment and atmosphere. Of course, your familiarity with different family members will vary: That's fine. The purpose of this instrument is not to provide a "correct" picture of the family, but to simply reflect your impressions of it. For example, if your experiences are largely limited to one parent, then answer according to that experience. 1. 2. 3. 4.  Family members Family members Family members Family members  really help and support one another. often keep their feelings to themselves. fight a lot. don't do things on their own very often.  Experiences of Interventionists 119  5. Family members feel it is important to be the best at whatever they do. 6. Family members often talk about political and social problems. 7. Family members spend most weekends and evenings at home. 8. Family members attend church, synagogue, or Sunday School fairly often. 9. Activities in the family are pretty carefully planned. 10. Family members are rarely ordered around. 11. Family members often seem to be killing time at home. 12. Family members say anything they want to around home. 13. Family members rarely become openly angry. 14. Family members are strongly encouraged to be independent. 15. Getting ahead in life is very important in the family. 16. Family members rarely go to lectures, plays, or concerts. 17. Friends often come over for dinner or to visit the family. 18. Family members don't say prayers. 19. Family members are generally very neat and orderly. 20. There are very few rules to follow in the family. 21. Family members put a lot of energy into what they do at home. 22. It's hard for family members to "blow off steam" in the home without upsetting somebody. 23. Family members sometimes get so angry they throw things. 24. Family members think things out for themselves. 25. How much money a person makes is not very important to family members. 26. Learning about new and different things is very important in the family. 27. Nobody in the family is active in sports (e.g., Little League, bowling, etc.) 28. Family members often talk about the religious meaning of Christmas, Passover, or other holidays. 29. It's often hard to find things when family members need them in the household. 30. There is one family member who makes most of the decisions. 31. There is a feeling of togetherness in the family. 32. Family members tell each other about their personal problems. 33. Family members hardly ever lose their tempers. 34. Family members come and go as they want to. 35. Family members believe in competition and "may the best man win." 36. Family members are not that interested in cultural activities. 37. Family members often go to movies, sports events, camping, etc. 38. Family members don't believe in heaven or hell. 39. Being on time is very important in the family. 40. There are set ways of doing things in the home. 41. Family members rarely volunteer when something has to be done at home. 42. If family members feel like doing something on the spur of the moment they often just pick up and go. 43. Family members often criticize each other. 44. There is very little privacy in the family. 45. Family members always strive to do things just a little better the next time. 46. Family members rarely have intellectual discussions. 47. Everyone in the family has a hobby or two. 48. Family members have strict ideas about what is right and wrong.  Experiences ofInterventionists\20  49. Family members change their minds often. 50. There is a strong emphasis on following rules in the family. 51. Family members really back each other up. 52. Someone usually gets upset if a family member complains. 53. Family members sometimes hit each other. 54. Family members almost always rely on themselves when a problem comes up. 55. Family members rarely worry about job promotions, school grades, etc. 56. Someone in the family plays a musical instrument. 57. Family members are not very involved in recreational activities outside work or school. 58. Family members believe there are some things you just have to take on faith. 59. Family members make sure their rooms are neat. 60. Everyone has an equal say in family decisions. 61. There is very little group spirit in the family. 62. Money and paying bills is openly talked about in the family. 63. If there's a disagreement in the family, family members try hard to smooth things over and keep the peace. 64. Family members strongly encourage each other to stand up for their rights. 65. Family members don't try that hard to succeed. 66. Family members often go to the library. 67. Family members sometimes attend courses or take lessons for some hobby or interest (outside of school). 68. In the family each person has different ideas about what is right and wrong. 69. Each family member's duties are clearly defined. 70. Family members can do whatever they want to. 71. Family members really get along well with each other. 72. Family members are usually careful about what they say to each other. 73. Family members often try to one-up or out-do each other. 74. It's hard for family members to be by themselves without hurting someone's feelings in the household. 75. "Work before play" is the rule in the family. 76. Watching TV is more important than reading in the family. 77. Family members go out a lot. 78. The Bible is a very important book in the family's home. 79. Money is not handled very carefully in the family. 80. Rules are pretty inflexible in the household. 81. There is plenty of time and attention for everyone in the family. 82. There are a lot of spontaneous discussions in the family. 83. Family members believe you don't ever get anywhere by raising your voice. 84. Family members are not really encouraged to speak up for themselves. 85. Family members are often compared with others as to how well they are doing at work or school. 86. Family members really like music, art, and literature. 87. In the family, the main form of entertainment is watching TV or listening to the radio. 88. Family members believe that if you sin you will be punished. 89. Dishes are usually done immediately after eating. 90. Family members can't get away with much.  Experiences of Interventionists\2\  Appendix E Autism Behavior Checklist (ABC)  Examiner INSTRUCTIONS: Circle the number to indicate the items that most accurately describe the child Whirls self for long periods of time Learns a simple task but "forgets" quickly Frequently does not attend to social/environmental stimuli Ooes not follow simple commands given once (sit down, come here, stand up) Does not use toys appropriately (spins tires, etc.) Poor use of visual discrimination when learning (fixates on one characteristic such as size, color, or position) . . . Has no social smile Has pronoun reversal (you for I, etc.) Insists on keeping certain objects with him/her Seems not to hear, so that a hearing loss is suspected Speech is atonal and arhythmic Rocks self for long periods of time Does not (or did not as a baby) reach out when reached for Strong reactions to changes in routine/environment Does not respond to own name when called out among two others (Joe, Bill, Mary) Does a lot of lunging and darting about, interrupting with spinning, toe walking, flapping, etc Not responsive to other people's facial expressions/feelings Seldom uses "yes" or "I" Has "special abilities" in one area of development, which seems to rule out mental retardation Does not follow simple commands involving prepositions ("put the ball on the box" or "put the ball in the box") Sometimes shows no "startle response" to a loud noise (may have thought child was deaf) Flaps hands Severe temper tantrums and/or frequent minor tantrums Actively avoids eye contact Resists being touched or held Sometimes painful stimuli such as bruises, cuts, and injections evoke no reaction Is (or was as a baby) stiff and hard to hold Is flaccid (doesn't cling) when held in arms Gets desired objects by gesturing Walks on toes Hurts others by biting, hitting, kicking, etc Repeats phrases over and over Does not imitate other children at play Often will not blink when a bright light is directed toward eyes Hurts self by banging head, biting hand, etc Does not wait for needs to be met (wants things immediately) Cannot point to more than five named objects Has not developed any friendships Covers ears at many sounds Twirls, spins, and bangs objects a lot Difficulties with toilet training Uses 0-5 spontaneous words per day to communicate wants and needs Often frightened or very anxious Squints, frowns, or covers eyes when in the presence of natural light Does not dress self without frequent help Repeats sounds or words over and over "Looks through" people Echoes questions or statements made by others Frequently unaware of surroundings, and may be oblivious to dangerous situations Prefers to manipulate and be occupied with inanimate things Will feel, smell, and/or taste objects in the environment Frequently has no visual reaction to a "new" person Gets involved in complicated "rituals" such as lining things up, etc Is very destructive (toys and household items are soon broken) A developmental delay was identified at or before 30 months of age Uses at least 15 but less than 30 spontaneous phrases daily to communicate Stares into space for long periods of time  TOTALS 1  + 2 + 3+ 4+ 5  = Total  Experiences of Interventionists\22  Instructions: 1. Circle the numerals following those behavioral characteristics that accurately describe the individual being rated 2. Sum the circled numerals in each column and record the total at the bottom of the column. 3. Sum the column totals to achieve a total score. 4. Transpose the total scores onto the ABC Summary Profile.  Additional instructions are on page 8 of the manual.  AUTISM BEHAVIOR CHECKLIST SUMMARY PROFILE  SENSORY  RELATING  26  38  BODY and OBJECT  19  (*12)  x • # +  Autistic Normal Deaf-Blind Severely Mentally Retarded o = Severely Emotionally Disturbed  12.  10 »14) .(0 13)  Ti7)-  TOTAL SCORE  31  \ (* lt  SOCIAL and S E L F HELP  LANGUAGE  -  °'°>-  .(» (o  8). 8).  = = = =  -(•44) -(042) -(»41)  8}-  « n r_  c  oi — o -  Raw Score  ©  1993 by P R O - E D ,  Inc.  Additional copies of this form (#6643) are available from P R O - E D , 8700 Shoal C r e e k Boulevard, Austin, T X 78757, 512/451-3246.  Experiences of Interventionists\22  Appendix F Modified Autism Behaviour Checklist (ABC)  PLEASE READ THESE INSTRUCTIONS SLOWLY AND CAREFULLY BEFORE COMPLETING THE FORM Thank you!  AUTISM BEHAVIOR CHECKLIST INSTR UCTION SHEET  The following form is about the child that you selected at the beginning of the study. On the Record Form (next page), circle the corresponding number in the left column to indicate the items that most accurately describe this particular child at this time. If an item does not accurately describe the child, do not circle the number. Please do not pay attention to the actual value of the corresponding number in the left column. Examples:  1  2  3 4  4  5 Whirls self for long periods of time 2  • •  Learns a simple task but "forgets" quickly  If the child whirls himself for long periods of time, CIRCLE the corresponding number (#4) in the left column. If the child does not engage in this behaviour, do NOT circle the corresponding number. Only circle the number in the left column if it accurately describes the child.  • •  If the child learns simple tasks but forgets them quickly, CIRCLE the corresponding number (#2) in the left column. If the child learns simple tasks and remembers them later on, do NOT circle the corresponding number. Only circle the number in the left column if it accurately describes the child.  Experiences ofInterventionists\24  AUTISM BEHAVIOR CHECKLIST RECORD FORM 2  1  4  3  4  5 7 z  4 1  2 2 2  3 3 3  2  4  4  3 2 3 2  4  3  4  3  3  4 4 3 2 2 2 2 3 3  1 2 2  4  1  4 4  2  1  3 3  1 3  4  4 3  4• 2  3 4  2  Poor use of visual discrimination when learning (fixates on 1 characteristic such as size color position} Has no social smile Has pronoun reversal (you for I, etc.) Insists on keeping certain objects with him/her Seems not to hear, so that a hearing loss is suspected Speech is atonal and arhythmic Rocks self for long periods of time Does not (or did not as a baby) reach out when reached for Strong reactions to changes in routine/environment  Has "special abilities" in one area of development, which seems to rule out mental retardation Does not follow simple commands involving prepositions ("put the ball on/in the box") Sometimes show no "startle response" to a loud noise (may have thought child was deaf) Flaps hands Severe temper tantrums and/or frequent minor tantrums Actively avoids eve contact Resists being touched or held Sometimes painful stimuli such as bruises, cuts, and injections evoke no reaction Is (or was as a babv) stiff and hard to hold Is flaccid (doesn't cling) when held in arms Gets desired objects bv gesturing Walks on toes Hurts others bv biting, hitting, kicking, etc. Repeats phrases over and over Does not imitate cither children at play Often will not blink when a bright light is directed toward eyes Hurts self by banging head, biting hand, etc. Does not wait for needs to be met (wants things immediately) Cannot point to more than five named objects Has not developed any friendships Covers ears at many sounds Twirls, spins, and bangs objects a lot Difficulties with toilet training Uses 0-5 spontaneous words per day to communicate wants and needs Often frightened or very anxious Squints, frowns, or covers eves when in the presence of natural light Does not dress self without frequent help Repeats sounds or words over and over "Looks through" people Echoes questions or statements made by others  Frequently unaware of surroundings, and may be oblivious to dangerous situations Prefers to manipulate and be occupied with inanimate tilings Will feel, smell, and/or taste objects in the environment Frequently has no visual reaction to a "new" person Gets involved in complicated "rituals" such as lining things up etc Is very destructive (tovs and household items are soon broken) 1 A developmental delay was identified at or before 30 months of age Uses at least 15 but less than 30 spontaneous phrases dailv rn m m m n n i n t p 1 Stares into space for long periods of tame  4  3  Leams a simple task but forgets quickly Frequently does not attend to social/environmental stimuli Does not follow simple commands given once (sit down come here stand up) Does not use toys appropriately (spins tires, etc )  Does not respond to own name when called out among two others (Joe Bill Mary) Does a lot of lunging and darting about, interrupting with spinning toe walking flappin" etc Not responsive to other people's facial expressions/feelings Seldom uses "ves" or "I"  4  1  Whirls self for long periods of time  Experiences of lnterventionists\25  Appendix G Demographic Form  1. Age  2. Gender (check one)  Male  Female  3. Highest level of education completed (check one)  4.  High school diploma  College diploma/certificate  Master's degree  Other (please describe)  Length of experience working with children with autism  Bachelor's degree years  months  5. Name of organization for which you currently work 6. Job title at your organization 7. Length of time employed by organization  years  months  8. Hours you currently work for organization as a behaviour interventionist:  hours per week  9. Number of families in the organization with whom you currently work 10. Number of children in the organization with whom you currently work 11. Training provided by the organization when you were first hired: TYPE OF TRAINING PROVIDED APPROXIMATE HOURS TRAINING RECEIVED 1. Attending workshops/lectures given by staff hours 2. Watching training videos 3. Reading training manual, articles, books, etc. 4. Participating in "on the job" training with supervision (i.e., staff present to provide feedback and support) 5. Observing other staff members work with a child 6. Other (please specify): 12. Ongoing training provided by the organization: TYPE OF TRAINING PROVIDED 1. Attending workshops/lectures given by staff  hours hours hours hours hours  APPROXIMA TE HOURS TRAINING RECEIVED  hours per  2. Watching training videos 3. Reading training manual, articles, books, etc.  hours per month hours per month  4. Participating in "on the job" training with supervision (i.e., staff present to provide feedback and support) 5. Observing other staff members work with a child  hours per hours per month  6. Other (please specify):  hours per month  Experiences of Interventionists \ 26  Appendix H Open-ended Questions  I N S T R U C T I O N S : Please answer the following four questions in point form.  1. What do you feel is/are the most stressful or challenging aspect(s) of your job as a behaviour interventionist?  2. What do you feel is/are the most rewarding or enjoyable aspect(s) of your job as a behaviour interventionist?  3. Please describe additional training and/or support that would help you to be more successful, skilled, competent, etc. in your work.  4. Is there any other feedback you can provide that has not been addressed in these questionnaires?  Check here if you have N O additional information to provide.  Experiences of Interventionists 131  Appendix L Instruction Sheet  Distribute to participants and read out loud while they follow along:  "The purpose of this study is to gather information about the people who work with children with autism in a family's home. These people have various job titles such as behaviour therapists, behaviour interventionists, and behaviour assistants. For the purposes of this study, the term "behaviour interventionist" will refer to people who provide one-on-one intervention to children with autism. In this study, you will be asked to fill out surveys and tests about occupational stress, coping resources, and the nature of a specific family and child with whom you currently work. To choose a family and a child, follow these instructions: •  Think of the m o s t c h a l l e n g i n g / d i f f i c u l t f a m i l y with whom you currently work. This family must be receiving services from the organization for which you are working.  •  Now think of the child with whom you currently work w h o is a m e m b e r If you work with more than one child in the family, choose the m o s t  of that family.  challenging/difficult child.  •  •  When completing the forms, think of the family and child that you have just selected and answer based on your experiences with that particular family and child ONLY. W H E N C O M P L E T I N GT H E FORMS, ANY  FAMILY  DO NOT PROVIDE T H E NAMES  OF  MEMBERS  Before filling out each test or form, please read each instruction sheet slowly and carefully, to ensure that you understand how to complete it. answer every question.  Please read each question carefully a n d  If you have any questions, please feel free to ask me for clarification."  Experiences of Interventionists 132  Appendix M Content Analysis of Most Rewarding Aspects of Bis' Work  CHILD VARIABLES C A T E G O R Y 1: LEARNING/PROGRESS/SUCCESS/IMPROVEMENT Participant # 001 002 004 007 008 009 010  012 013 014 015 016 017 018 019 020 022 023 024 025 026 027 028 029 030 031 032  Quote The development of the children Making a difference in the lives of the children that I work with Seeing children's progress When you see a child do something new To know that you're helping a child Watching the children learn Hearing their first words Seeing the children develop and gain independence The child I work with has great potential and learns many things over a day, week, month. It is rewarding to contribute to a child who is making progress. I have seen this child progress at amazing leaps and bounds. So many things against the odds in the home, but an autistic child trying so hard to learn. Watching a child grow and learn When the kids (understand) get a new concept for the first time When the child is getting through the programs and is overall successful When they learn something new Watching the progress in the games they are doing Seeing the progress the child makes socially and cognitively When the child finally understands/masters a difficult concept/task When watching the child improve Seeing improvements that result from the work I do Seeing the child progress and gain skills See progress child has made To witness the progress of the child Seeing improvements in the child's progress Seeing the child succeed When child has shown knowledge at new skills I've been working on All the successes and learning the child has All behaviour changes Seeing the results, the child getting more adjusted to the world around, being able to communicate better Seeing growth Seeing the child achieve/make progress Seeing a child progress Seeing improvements in the child The improvements that happen within a child are amazing  Experiences of Interventionists\33  033 034 035 036 037 038 039 041  042 043  044 045 047 048  049 050 051 053 054 055 056  Successes of the child Seeing the children's progress Seeing the child make progress Seeing the children progress Knowing the children are learning Seeing progress, no matter how small, in a child's behaviour, functional skills Watching the gains made by the children Watching children achieve goals Working, planning, and implementing strategies independently that do bring results for the child (e.g., attending at a table for 5 minutes) When a child reaches a goal When the children do something amazing and totally unexpected—when a child surpasses your expectations Realizing I have, in some way, enriched a child's life and have potentially made it possible for a child to make friends, play, have a job—things which may not have been possible without intervention When the child has successfully reached a goal (e.g., teaching the child greetings "Hi" and "bye," "How are you?"). When they respond, it is so exciting. Seeing a child progress Watching a child use skills you taught him to function more appropriately in life Teaching them [the child] how to learn and that learning is fun Having a child finally be able to say my name after 3 years Seeing children learn/develop Watching the changes in the children (from small steps to huge gains) The child's progress Working with a non-compliant child day after day and making a breakthrough The first words of a child Every time the child makes a step or leap forward Resolving behavioural issues or sensory issues Succeeding in getting and maintaining the child's attention and interest Knowing I am making a real difference for this child and their future I totally enjoy the children. The results of this program are very rewarding, even though sometimes it takes a while When the child reaches a goal The first time a child speaks my name Seeing the child use skills I have helped him/her attain [Child's] first words Seeing improvements with the children's behaviour/skill level Seeing the children progress is the most rewarding aspect of this job by far The successes the child has, whether they are large or small. It could be the point where the child finally "gets" a concept and you see the light come on... .Those are the moments that keep you coming back. Setting goals for the clients and striving towards our mission together, i.e.,  Experiences  057 058 059 060 061 062 063 064 065 066 067 Total coded responses  ofInterventionists\2>4  hope and ability to function effectively in the world regardless of the means. This results in reduced client frustration, behaviours, happy parents and long term community growth. I know I am on the right track when the client is calm and smiling despite all the hard work involved The gains the children make Recognizing improvement in any aspects of child's functioning Seeing the progression of a child's skills in all areas of their lives Seeing gains in progress and milestones made by the child Seeing progress in the children Seeing progress of child Every time the child makes a step forward, no matter how small Seeing the kids progress Seeing leaps in skills Seeing the children learn and grow Teaching kids skills needed to be part of a family, church, class, and/or community 78  C A T E G O R Y 2: E S T A B L I S H I N G A R E L A T I O N S H I P / C O N N E C T I O N ; PLAYING/HAVING FUN  Participant # Quote 003 Having a child be happy to see you when you arrive 008 Laughing with the children 012 Playing and learning with the child 013 When the kids are excited to see me 014 When they show me affection and look forward to me being there 015 Seeing the child enjoy themselves, smiling and laughing 018 Knowing that the child enjoys spending time with me I truly love and enjoy spending time with the child I work with 019 Having fun with the child 020 When child is happy to see you 021 Special bond between the child and you 022 Affection from the child Learning from the children's perspective 023 Seeing the child react positively to you Playing and having fun with children 027 Having fun and getting attached to children 031 Playing and being with children 037 Spending time with amazing children (playing) 039 Developing a trusting, loving, stable relationship with the child Receiving the child's trust and acknowledgement (over time) Having the child return eye contact, a smile  Experiences  041 043 044 045  050 051 053 055 057 058 063 064 065 067 Total coded responses CATEGORY Participant # 005 028 032 046 053 062 065 Total coded responses  ofInterventionists\25  The sense of humour children with ASD possess Making a child laugh Intervention is fun That first moment when you connect on some level with your child for the first time Hearing laughter from child Establishing eye contact/joint attention Getting a hug or smile Learning about the world through the eyes of the children Just being around children Making them smile and laugh Playing with the children Bear hugs when you go through the door Having the child go from rejecting you to welcoming you Play time is fun - usually .. .a really successful play session where you both really enjoyed yourselves. The fun times (i.e., when the children are social, laughing, etc.) Working one-on-one with kids (getting to know them) Building trust with the kids, playing games that make them laugh When child complies and "has fun" with me (smiles, plays games, etc.) Feedback from the kids (e.g., hugs, smiles) Opening the world to kids to enjoy 42 3: OTHER/DON'T KNOW Quote Working one-to-one with kids The kids Most definitely the children Working with the children The kids I enjoy the challenges that each day brings with the children. Each day is different, and when things settle down (behaviours), there is always something else that pops up—new behaviour, problems, rigidity, etc. Helping children 7  TOTAL CHILD RESPONSES: 127 PERCENTAGE OF RESPONSES: 127/231 = 55%  Experiences ofInterventionists\2>6  F A M I L Y VARIABLES HELPING FAMILIES Quote Participant # The decrease in anxiety in the parents 001 Making a difference in the lives of the families that I work with 002 Feeling welcome and trusted in another person's home 003 Knowing that you are making a positive difference in families and helping 004 them be successful Working with families 005 To know that you're helping a family 007 Making the parents happy and their life easier 008 Assisting the family to be more successful and independent in their daily 009 routines Hearing the parents say they see an improvement in their child 013 When the parents tell me they've seen a change in their child for the better 014 When parents see the changes 017 Knowing that I'm appreciated by the parents 018 Appreciation from the parents 020 Pulling a family together 021 Family telling you how you've made a positive difference 024 Meeting new families 030 Making new friends with family members The improvements and changes that happen within a family are amazing 032 Being exposed to so many amazing families and knowing that in even small 037 ways I've contributed to the improvements of their lives Seeing family pride 038 Developing a trusting, loving, stable, relationship with the families 039 Helping families to function better (e.g., to cope better) 041 When parents are proud of their child's successes I feel that I'm doing my job 042 Seeing a mother's face light up when a child says something or asks for 043 something for the first time Seeing families "become" families 044 Seeing parents move from feelings of hopelessness to being hopeful 045 Hearing laughter from family Feedback from family 047 Being thanked by the parents for my work with their child 048 Siblings playing together 051 Parents saying thank you The complete gratitude of the families—one family refers to me as "their 053 daughter" so that is nice Knowing that I am making a difference in a family's life is very rewarding. It 054 makes the hardships worth it.  Experiences of Interventionists 137  059  060 061 065 066  Total coded responses  Seeing the difference you can make in how a family copes with daily living tasks by teaching/providing them with the tools to cope better Smiles on parents faces when they see that their child can do it, or that the parents themselves can do it Assisting the family in coping with their child's disorder and giving hope for the future Seeing satisfaction in eyes of parents Helping families Getting feedback from the families on their children It is also nice as an in-home therapist to observe the parents who embrace the suggestions given to them and really work with their children to give them as much help and support as possible 40  T O T A L F A M I L Y RESPONSES: 40 PERCENTAGE OF RESPONSES: 40/231 = 17% T E A M VARIABLES WORKING AS PART OF A T E A M Participant # Quote The appreciation felt by Bis for my assistance 001 Being part of a good team 003 Learning from others 004 Working with a great group of coworkers and like-minded people Working with other Bis 005 Working as a team 006 Learning from others on staff Being in the school setting or organizational events where other 019 interventionists or people are around 025 Friendly faces when I go to work Praise is not verbal well at least visually by friendly warm adult interactions 032 Knowing that my voice is heard at team meetings or when speaking to a supervisor I enjoy that I now train and offer advice to new staff when they begin Hearing someone attribute [the child's progress] to the time and effort I've put 035 in Positive collaboration with coworkers to solve a problem 037 Working closely with a therapist (co-teaming) on challenging behaviour or 039 goals that eventually bring success 041 Working with a team 042 I believe that this program and job would not be as successful as it is if it wasn't for Donna. She is very involved and passionate about these children and her staff. It's the best job I have ever had 043 I have been very impressed at how supportive our workers are to each other  Experiences of Interventionists 138  046 047 053 062 05 067 Total coded responses  Team aspect, social environment Feedback from community members involved with child Having your team acknowledge your work - success Having support from other team members - speech, OT psych, and supervisor—all who are very supportive and encouraging Learning from others Using my skills and knowledge to teach others 24  TOTAL T E A M RESPONSES: 24 PERCENTAGE OF RESPONSES: 24/231 = 11% JOB VARIABLES C A T E G O R Y 1: POSITIVE ASPECTS OF THE JOB/AGENCY/WORK ENVIRONMENT Quote Participant # 9:00-5:30 hours 004 Learning new techniques 006 Being encouraged to learn Going on fieldtrips 019 The money 021 Field trips The simplicity of the workplace (no office politics) 022 Creative license over learning strategies Being able to use creativity in work, finding unusual solutions, etc. 027 Fast-paced environment - no time to get bored, think about problems, etc. Learning 028 Learning 029 Somewhat flexible schedule 031 Variety of contexts 044 Flexibility in organizing how I do things 046 I enjoy the structure and the fast pace and the fun 049 Acquiring more skill/knowledge 053 Total coded 17 responses CATEGORY Participant # 050 053 056 065  2: OTHER/DON'T KNOW Quote Doing crafts Every day is a challenge I enjoy working with focus and mission Having control over environment  Experiences of fnterventionists\29  Total coded responses TOTAL JOB RESPONSES: 21 PERCENTAGE OF RESPONSES: 21/231 = 9% G E N E R A L QUOTES RE: ENJOYMENT OF THE JOB AND M A K I N G A DIFFERENCE Participant # Quote 005 Seeing improvements 006 Seeing the progress 008 Seeing results 021 Knowing you made a difference 022 The feeling of having contributed to someone's success/happiness 023 Knowing I am making a difference in another person's life 024 Knowing you make a difference 028 Making a difference Having fun 029 031 Feeling you made a difference 038 Contributing towards successes Lots of wonderful memorable moments 040 Successes Smiles Laughter 041 Feeling my work is important 047 Knowing I am making a difference 048 Watching the successes 059 Just knowing you are making a difference and helping people Total coded responses 19 TOTAL OTHER RESPONSES: 19 PERCENTAGE OF RESPONSES: 19/231 = 8% TOTAL NUMBER OF CODED RESPONSES FOR QUESTION #2: 231  CHILD FAMILY JOB TEAM OTHER TOTAL  NUMBER OF RESPONSES 127/231 40/231 21/231 24/231 19/231 231/231  PERCENTAGE 55% 17% 9% 11% 8% 100%  RANK 1 2 4 3 5  Experiences of Interventionists\40  Appendix N Content Analysis of Most Stressful Aspects of Bis' Work  QUESTION # 1 - MOST STRESSFUL ASPECTS OF T H E JOB CHILD VARIABLES C A T E G O R Y 1: ENGAGING/MOTIVATING THE CHILD Participant # Quote 003 Working in an environment where a child has all their preferred activities and items at their disposal and working to engage them in something they don't want to do 016 Child not wanting to do anything and needing full prompting to get through it 032 Trying to keep the program fun and interesting for the child 048 Finding ways to engage the child whey they are being detached/uninterested/unfocussed 059 Finding the energy to keep our kids motivated on those days when you're not so motivated yourself Total coded 5 responses CATEGORY Participant # 021 028 051 053 065 Total coded responses  2: L A C K OF PROGRESS Quote Feeling of helplessness, in regards to the child Not always seeing progress (slow progress) Not seeing any improvement when methods are being changed Repetitive trials, sometimes without observable gains can be disheartening The stress related to lack of progression in skills 5  C A T E G O R Y 3: CHALLENGING BEHAVIOUR Participant # Quote 013 Dealing with difficult behaviours that happen often (e.g., throwing things) 015 Constant mood swings of the child Extreme fits of anger and sadness from child 018 Dealing with behaviour problems of the child and acting as the disciplinarian (i.e., following thru with consequences) 019 Being hurt physically by child (biting, kicking) 023 Dealing with child's inappropriate behaviour 024 Behaviour management, especially in public when other people don't understand the situation as a whole (tantrums, hitting, screaming) Finding plausible causes for behaviours—sometimes there are no known reasons and it is hard to find something that doesn't seem to be there  Experiences of Interventionists 141  028 029 031 033 037 041 043 047 048 064  Handling difficult behaviours Finding new effective ways to address behaviour problems Dangerous work environment (child biting, hitting, etc.) Managing behaviour of the child Doing a functional analysis of a child's behaviour Challenging behaviours (e.g., shouting, high anxiety)—being able to remain calm myself Challenging behaviours/tantrums—they make you sweat! Working with a non-compliant child day after day Remaining neutral when being physically hit/kicked Dealing with oppositional behaviours  Total coded responses  18  C A T E G O R Y 4: OTHER/DON'T KNOW Participant # Quote 023 Making decisions based on consequences for the child 024 Inclusion of child in environmental setting with other children without disabilities 067 Challenge of the children who you work with Lack of conversation if child is nonverbal Having child as a passenger in a car—feel responsible for them; can be overwhelming Total coded responses 5 T O T A L NUMBER OF CHILD CODED RESPONSES: 33 PERCENTAGE OF CHILD RESPONSES: 33/259 = 13% F A M I L Y VARIABLES C A T E G O R Y 1: WORKING IN A F A M I L Y ' S HOME Participant # Quote 002 Families trying to put you in the middle of their personal problems Language barriers 003 Understanding cultural differences Entering into a family's private space Dealing with not only what is going on with your child but their entire family Not getting caught up in the family's problems 004 Working in such a personal space (homes); it is difficult at times to establish personal boundaries 008 Some families do not have proper working areas for us to do intervention and organize our materials  Experiences of lnterventionists\42  009  010  018  031 033  035 040 041 044 049 053 055 059 061 062  Not enough structure in families' homes Working in the home of strangers and recognizing that every family has its own rules, values and expectations.. .1 must "uncover" what these are for each family so that I may comply with them. However, sometimes these values, etc. are 'hidden' and I discover them only once I've unknowingly violated them. And each family is different so I'm forced to discover these "home values" for each child.. .so in 1 work day if I see 3 kids then I'm in 3 different environments all with different rules. Dealing with the child's stressed parent, multiple personal problems Working in the home setting—seeing financial difficulties, verbal arguments between the parents or arguments with other family members Working in basement without a window, dirty stinking cat litter box in the laundry room beside the therapy room, the stink of heavy cigarette smoke, limited access to washroom Inadequate storage available for program materials; siblings/friends getting into materials and scattering them over the house Dealing with parental issues—parents see me as a therapist for them more so than an aide for their child Knowing where the boundaries are in my relationship with the family I work with Being in someone's home Working in the home—I experience stress related to circumstances in the home such as Mom telling me stories about her personal life, relatives visiting Working in the home—Mom smoking cigarettes, children trying to play in the therapy room during my paperwork time; children destroying materials or toys during the time I am not at work Also, the parents seem to become dependent on us as interventionists and do not see us as individuals who need support/relief too. In the eyes of the parents our training and education seem to be undermined Being involved in family issues Families who are struggling emotionally/financially and take it out on interventionists (and interventionist's lack of ability to help family) Maintaining boundaries with families Finding a balance between advocating and involving families without adding to their stress level Keeping distance from families so as to not put yourself in awkward positions Being directly in a tension-filled home environment Working in this position has made me see the "job satisfaction" advantage to working in a center-based program as opposed to home-based. I would definitely consider changing jobs if another opportunity arose Fitting in the family's environment, in their home and with their routines/lifestyle Adapting to new households and families Working someone else's home rather than a classroom (home = private); feel awkward asking for things for child (e.g., snack, cup) and feeling as if I'm intruding into their lives  Experiences of Interventionists\42  066  067 Total coded responses  Being in a home-based program, because you need to be careful in approaching the family and their culture and beliefs and values while spending a large portion of the day in their home and they need to maintain their views alone with adopting our program policies and recommendations Parents dependent on me being there—if I'm sick and there are no relief staff their whole world can collapse by spending an unscheduled day with their child 32  C A T E G O R Y 2: CONFLICT/INCONSISTENCY/LACK OF SUPPORT Participant # Quote 007 [Inconsistency between family members and program 010 Seeing a child's primary needs neglected (food, cleanliness, clothing) Seeing siblings similarly neglected 013 Helping the families understand why we are doing some of the things we do (e.g., teaching a nonverbal child PECS to communicate when the parents want him to talk) 014 When parents have a concern they tell my supervisor instead of me. I don't mind them telling me how to work—I just wish the parents would tell me first, so that I can change right away. My supervisor is busy and might not get back to me for a week—at this time the parents are getting impatient and I don't know the reason 016 Parents not liking the idea of making their child do things the child doesn't want to do Parents don't follow through with self help skills or ignoring of behaviours Parents having camera set up peeking through the floor boards on the ceiling being used to spy on Bis 017 Working with parents when you both want what is best but disagree When you know something would be beneficial but parents disagree When I disagree with what family believes 019 Family is never home Family will not address troublesome issues Family does not work with the team Family lies to the team about what is happening at home and their relationship with the child Family will not get training to be able to better deal with their child Family calls me in to work when the child is sick 020 Lack of support from family 022 Long quote Dealing with the parents—far too often parents fail to continue with our approach outside of IBI hours... 027 Feeling conflicts between what you were taught and believe is right to do and parent's opinion/behaviour 036 Parents not valuing our input 038 Lack of communication with families 046 Parent's views can be conflicting with what I'm doing, or what the  Experiences  of  Interventionists\44  067  organization represents Parents not complying with generalization strategies Working very hard with a child and not having the family follow through Reassuring particular parents that some of the strategies and inters? n tions being used for their children are valuable and necessary. Parents who undo everything you do or take no interest in their child's program Dealing with parents, especially when they don't help follow through with goals High maintenance parents who unknowingly sabotage therapy goals  Total coded responses  29  048 051 056 063 064  CATEGORY 3: FAMILY EXPECTATIONS  Participant # 008 015 019 041 Total coded responses  Quote Some parents expect sudden rather than gradual results (parental expectations too high) The family expecting the child to get better, which does not happen so quickly, then suggesting it's me not doing my job. Family just wants us to fix their child Working with challenging families—families with unrealistic expectations, or who place unrealistic demands on interventionists because of lack of knowledge (e.g, ASD, typical child development) 4  CATEGORY 4: OTHER/DON'T KNOW  Participant # 036 037 043 058 062  Quote Working with difficult parents/family situations Dealing with "high maintenance" parents Parents Dealing with parents regarding or during negative behaviours displayed by the child Dealing with the family members  Total coded responses  5  Experiences  of  Interventionists145  TOTAL NUMBER OF F A M I L Y CODED RESPONSES: 70 PERCENTAGE OF RESPONSES: 70/259 = 27% T E A M VARIABLES CONFLICT/I NCONSISTENCY/LACK OF SUPPORT BETWEEN T E A M M E M B E R S Participant # Quote 001 Abil y to assist and support all Bis on my team in a one month schedule Balance between when I should say an opinion and when to step back and allow my senior to do his/her job without question 002 Not enough support from SLP, OT, senior Bis 004 At times working as a team creates challenges (e.g., scheduling time to meet, differences in opinion, certain people not following through with their responsibilities) Communication—because many people are away from the office for longer periods of time with different schedules, time sensitive issues/messages do not get passed on 005 Getting others to do their jobs Getting answers/support Dealing with many supervisors 006 When I'm not given information about a child or family that might help me in working with them 012 Answering questions other parents ask about the child I'm working with 014 No support from OTs or SLPs—the 2 children I work with go to segregated sites so I am left on my own without support 016 Lack of support from supervisors Feeling as though the supervisors will do everything to keep peace even if it means making grey areas in the policies 017 Contact with office/getting a hold of people 018 Feeling I'm in the middle as a mediator at team meetings, between parents and the clinical staff Deciding whether to fulfill what my supervisor wants done and what the parents want done, when the two are often conflicting 021 Lack of communication regarding priorities or duties Lack of appreciation 025 Keeping both family and supervisor happy with my work when it's really the child's needs that are important 030 Poor communication with supervisor Unrealistic expectations 031 More than one supervisor Lack of effective 2 way communication between BI and supervisors Little recognition 032 With SLPs, OTs, supervisors and consultants adding input it's hard to balance all of their interests  Experiences of Interventionists\46  034 035 036 037 038  039 041 043 044 046 047 048  049  053  056 061 063  Some office staff are unapproachable when faced with administrative questions Disorganization of one particular supervisor The lack of respect we get from office staff I feel stress when supervisors and consultants are the almighty and some of them have the attitude that we must all bow to their power Trying to incorporate everyone's ideals about what should be done, when, how and why. There are many different viewpoints coming from many different areas and many different relationships to the child. Receiving conflicting messages from supervisors and clinical staff on how to do things Office staff not valuing our input Working as a team with coworkers who have completely opposing views and styles and strategies to working with these children Inconsistencies in program planning, record keeping, and communicative methods Lack of communication among team members Unanswered questions Varying work styles within this environment and class room Varying philosophies—some opposing Work habits of coworkers include unprofessional behaviour Lack of direction from therapists (OT, SLP, Psych) Not enough direction from team Lack of program development by clinical staff Not enough input from clinical team (SLP, OT, Psychologist) People around me moving on things slower than I'd like Dividing work load between interventionists so it is not all done by one person Watching a child move into school/preschool and be challenged—wanting to go and help their aides work with them more productively Fair division of preparatory work between all Bis in the home It would be helpful to have a specific forum for all the behaviour assistants of a house to share their experiences—without this we tend to be doing things slightly differently for some time before it is caught There are a lot of people involved and each person feels things should be done the way they perceive it Lack of communication between team members 1 often feel that I'm unclear about expectations Information is also not passed on to appropriate people Directions from the clinical coordinator that is contradictory to what our behaviour coordinator is telling us Being responsible for handling unforeseen behaviours without direct support (immediate support) Working with other staff who are bossy or intrusive Working in collaboration with another therapist for one child Being introduced as the second therapist once one has already been established Consultants (SLPs, OT, Psychologist) all giving goals to work on  Experiences of Interventionists] 47  066  Total coded responses  Everyone on the team has their own ideas and our approach to therapy is a little bit flexible, so there can be several different views and. suggestions all on one child. This is beneficial, unless there is weakness in communication and lack of unity on the team 59  T O T A L NUMBER OF T E A M CODED RESPONSES: 59 P E R C E N T A G E OF RESPONSES: 59/259 = 23% JOB VARIABLES C A T E G O R Y 1: ORGANIZATIONAL/AGENCY ISSUES Participant # Quote 003 Office politics 006 When materials aren't available It's difficult to be in this field when there aren't many positions to move into. I do enjoy my job, but it's because I'm going out of my way to learn new things and take on more responsibility than is required. I'm bored with my actual job and need to move up or I'll look elsewhere 020 Politics within the company 026 All the paper work and documentation, sometimes exact times, or exact measurements 027 Not being paid for sick days (or when family has to leave for a long period of time and there's not enough shifts to sub for). Less money and having to consider going to work when really sick 030 Lack of training No sense of job identity 031 No room to move up (position and money wise) 034 The inability to move up in the company 035 We do not receive sick days (paid) yet we are surrounded by children who carry germs all day 039 Work environment very crowded, small, windowless area No privacy, noisy, no natural light—25 people in this space Entrance to work area connects to a busy, bright hallway used for intervention activities 044 Bureaucracy 045 Finding enough materials/resources to set up programs/interventions 061 Feeling like you're at the bottom of the totem pole within the organization 064 Extra paperwork, planning, etc. 065 Lack of personal work space at office Lack of supplies and resources Total coded responses | 20  Experiences of lnlerventionists\\%  CATEGORY 2: ISOLATION Participant # Quote 004 Being isolated in homes versus coming to an office with coworkers for 8 hours/day 015 No one to talk to and know that they understand what I say 8 hours/day, 5 days/week; no one talks to me all day long during my 8 hours 018 . Working alone for most of the day with little contact with colleagues 019 Being isolated 028 Isolation from other people in the same job 030 Feeling isolated 036 Working alone with the child Not seeing other coworkers on a daily basis to trouble shoot Not knowing other interventionists 053 Lonely—we work on a team but very rarely get to sit down with them and get support/understanding 055 Isolation—each 4 hour session is essentially spent alone with the child 057 Being alone in the home (i.e., no other Bis around if you need help with behaviours) 059 Working alone in the home with no immediate support from coworkers 060 Isolation because we work one-on-one with our clients inside the home. Also, due to the intense nature of our job our focus remains mostly on the client when out in the community, further stifling opportunities to talk out problems, vent, or get immediate support from others 065 Lack of contact with team and staff on day to day 067 Lack of contact with other adults Total coded 17 responses C A T E G O R Y 3: TIME PRESSURE Participant # Quote 019 Having to drive to another workplace in the afternoon 027 Time pressure—tons of things to do with the child, paperwork, and driving a lot to be on time for the other family 032 Some work that needs to be done after work; preparing materials at home— doesn't allow for separation of work and home life 037 Not having enough time to consistently do all that is needed or could be done to help the child's program 038 Not enough time to complete all the tasks I want to get done 039 Getting everything done that needs to be completed in a day 041 Taking work home because of a lack of prep and planning time Lack of opportunity to debrief with coworkers 044 Not enough time to develop programs Driving, always on the go 045 Finding time to debrief with coworkers 046 Many things to do and places to be and no time  Experiences of Interventionists\4^  047 053 057 059 063 064 Total coded responses CATEGORY Participant # 003 006 012 018 024 025 026 029 041  042 043 045 046 047 048 050  Feeling rushed to set up/clean up a session Having numerous programs and limited time to do them No breaks, just 5 minutes to relax Finding time in the day to make sure you get everything covered regarding kid's goals Sometimes there isn't enough time to do everyone's goals Getting all areas to work on/objectives done daily 18 4: JOB PERFORMANCE/JOB RESPONSIBILITY Quote Performing in front of the parents Being faced with a new challenge when others are watching Feeling unprepared to handle situations that creep up Saying the wrong things Not feeling like I'm making any difference Keeping control of the situation Being alert and quick to prevent stuff Listening to yelling and not reacting Seeing things fly and not react Quick thinking Quick responses Coming up with new ways to get things done (e.g., change the way you work with the child) Uncertainty re: am I focussing on the right goals, is this the best way to approach this goal? Overwhelming feeling of responsibility - the work I do is affecting this child's life and potential to function independently in the world Trying to maintain my skills—since children's behaviours and needs change I find that I have to readjust and change my style. When this occurs, I tend to forget or misuse my skills There has been a lot of stress around this being a new program and building it from the ground up Keeping ideas fresh and innovative Keeping energized/motivated Combining family needs, child needs, and program needs/requirements Prioritizing Theories and opinions on what is right for each individual child and living up to those expectations Waiting for video review feedback Knowing what next step to take when you've tried a few different approaches to a problem and are still not seeing successes Coming up with a new and/or interesting art craft idea every day Video reviews, although I truly do benefit from them and find them extremely  Experiences  053  054  058 Total coded responses  of Interventionists\  helpful Being under scrutiny of UBC for success of program for other families who will need the service in the future—if I screw up or fail, it will have farreaching effects Being under the scrutiny of parents and being compared to other Bis Intensity of the intervention—I've been doing this for over 3 years now and I can feel myself begin to burn out The job has high demands and consequences—we're trying to help shape the rest of these children's lives and that weighs heavily on my shoulders Identifying/meeting the needs of the child adequately 31  C A T E G O R Y 5: L E N G T H OF SESSION Participant # Quote 004 Scheduling—the needs and limits of the children are put behind the program's requirements to fill their 20 hours of intervention (i.e., 5 hour shifts with 3 year olds) 006 Trying to fill a 4 hour session with productive and useful material 007 Long shifts 4 hour sessions—too long for some children 008 055 3 hours of intervention require you to be dealing with some of the child's most challenging times as you are putting a lot of expectations and demands on the child Total coded 5 responses CATEGORY Participant # 003 005 017 041 050 Total coded responses  6: OTHER/DON'T KNOW Quote Not taking work home Doing work without being interrupted When I disagree with what work believes Taking work home emotionally Driving in the snow 5  TOTAL NUMBER OF JOB CODED RESPONSES: 96 PERCENTAGE OF RESPONSES: 96/259 = 37% RANK NO. RESPONSES PERCENTAGE 33/259 13% CHILD 70/259 27% FAMILY 23% 58/259 TEAM 37% 97/259 JOB 259 100% TOTAL  4 2 3 1  50  Experiences ofInterventionists\S 1  Appendix O Code Book for Most Enjoyable Aspects of Bis' Work  General procedure for analyzing the quotations: 1. Read the quote and determine which of the following 4 general categories it belongs in : 1) Child - quote refers to the child 2) Family - quote refers to the parents or family members 3) Team - quote refers to working with other team members, excluding parents 4) Job - quote refers to aspects of the organization or agency (e.g., office space) or to particular aspects of the job itself (e.g., working alone with kids) 5) Other - general quote referring to enjoyment of the job and making a difference 2. Remember that one sentence may contain more than one concept and therefore belong in more than one category. This happens occasionally, but is not common. Be sure to read the content of the sentence and determine whether it deals with only one category, or more than one category. If the quote refers to more than one category, break it down into its smaller parts and categorize each of the parts separately. For example, the quote "Trying to work with OTs and SLPs and do their goals while keeping intervention interesting for the child." This can be divided into 2 categories: 1) team variables (trying to work with OTs...), and 2) child variables (keeping intervention interesting for the child). Thus, this quote deals with 2 separate issues and should be categorized separately. 3. Once you have determined which general category the quote belongs in, go to that category and determine which of the specific subcategories it belongs in. 4. Not all categories have subcategories; therefore, some quotes may be filed just under the larger category heading and do not need to be further categorized.  CHILD V A R I A B L E S C A T E G O R Y 1: LEARNING/PROGRESS/SUCCESS/IMPROVEMENT Quotes in this category refer to: • Child making progress and achieving goals in a variety of areas such as academics, skill development, language development (e.g., child sayingfirstwords or saying BI's name) • Child developing, learning, growing, succeeding, achieving, improving, making gains • Teaching the child functional skills that s/he uses in everyday life • Positive behaviour changes in the child • Making a difference in the child's life (either the quote itself or the context of the sentence must refer specifically to the child in order for it to be categorized here) C A T E G O R Y 2: ESTABLISHING A RELATIONSHIP; PLAYING/HAVING FUN Quotes in this category refer to:  Experiences of Interventionists\ 52  • • • • • • • •  Establishing a relationship/connection/bond with a child Receiving physical affection from a child (e.g., hugs) Playing/having fun/laughing with a child Becoming attached to a child Child making eye contact Child reacting positively to BI (e.g., smiling, showing excitement) Learning about the world from the perspective of the child The quote must refer specifically to the child for it to be categorized here. Any quotes that refer to learning in general is categorized elsewhere  Note: quotes in this category emphasize the relationship between the BI and child  CATEGORY 3: OTHER/DON'T KNOW Any quotations that refer to child variables but do not belong in the above 2 categories should be placed here. This includes quotations that are too vague to accurately categorize—that is, not enough information has been provided to enable you to accurately categorize the quote and place it into a specific subcategory.  FAMILY VARIABLES HELPING FAMILIES Quotes in this category refer to: • Contributing to a family's well being, success, happiness, improvement • Feeling valued/appreciated by families; being thanked by families • Establishing relationships with families • Making a difference in families' lives • Helping the family to adjust and cope with their life situation • Witnessing families use the intervention strategies and support their child to succeed • Families seeing and reporting changes themselves  T E A M VARIABLES WORKING AS PART OF A T E A M Quotes in this category refer to: • Working with other team members • Teaching/training other team members • Feeling part of a team; feeling valued as a team member • Collaborating with other team members • Being acknowledged/appreciated by other team members for work done by the BI • Friendly interactions with team members • Learning from team members • The quote must refer specifically to learning from others to be categorized here. If the quote just refers to learning, but doesn't specify learning from people, it is categorized under job variables  Experiences of Interventionists\S3  Note: "team members " not only refers to team members who work with the BI within the organization, but other community members who are involved with the child. Team does not include the parents or family. Note: the term "others " is assumed to refer to team members other than the parents/family and is categorized under the Team category. That is, if the quote refers to others, but is not clearly referring to either the parents/family (or child), it belongs here.  JOB V A R I A B L E S C A T E G O R Y 1: P O S I T I V E A S P E C T S O F T H E J O B / A G E N C Y / W O R K ENVIRONMENT  Quotes in this category refer to: • Flexible work hours • Variety of work environments • Fast pace of the job • Going on fieldtrips • Pay/salary • Opportunities for creativity • Simple work environment • Learning on the job; acquiring skill or knowledge - only categorize here if the quote does not refer to learning from other people (just learning in general) C A T E G O R Y 2: O T H E R / D O N ' T K N O W  Any quotations that refer to job variables but do not belong in the above category should be placed here. This includes quotations that are too vague to accurately categorize—that is, not enough information has been provided to enable you to accurately categorize the quote and place it into a specific subcategory. G E N E R A L QUOTES RE: ENJOYMENT OF T H E JOB AND M A K I N G A DIFFERENCE  Quotes in this category refer to: • Making a difference or seeing improvement, progress, or success B U T do not refer specifically to the child or family. Thus, if it cannot be determined to whom the quote refers (i.e., a general quote), it should be included here. • BI feeling like her work is important • Helping people, but does not refer specifically to whom is being helped • Enjoyable or memorable moments (general) • Enjoyment of the job (e.g., having fun), but do not belong in any of the above categories • Seeing smiles and laughter, but do not refer specifically to anther person. Thus, if it cannot be determined to whom the quote refers (i.e., a general quote), it should be included here.  Experiences of Interventionists 154  Appendix R Code Book for Most Stressful Aspects of Bis' Work  General procedure for analyzing the quotations: 1.  Read the quote and determine which of the following 4 general categories it belongs in : a) Child - quote refers to the child b) Family - quote refers to the parents or family members c) Team - quote refers to working with other team members, excluding parents d) Job - quote refers to aspects of the organization or agency (e.g., office space) or to particular aspects of the job itself (e.g., working alone with kids) 2. Remember that one sentence may contain more than one concept and therefore belong in more than one category. This happens occasionally, but is not common. Be sure to read the content of the sentence and determine whether it deals with only one category, or more than one category. If the quote refers to more than one category, break it down into its smaller parts and categorize each of the parts separately. For example, the quote "Trying to work with OTs and SLPs and do their goals while keeping intervention interesting for the child" can be divided into 2 categories: 1) team variables (trying to work with OTs...), and 2) child variables (keeping intervention interesting for the child). Thus, this quote deals with 2 separate issues and should be categorized separately. 3. Once you have determined which general category the quote belongs in, go to that category and determine which of the specific subcategories it belongs in.  CHILD V A R I A B L E S C A T E G O R Y 1: E N G A G I N G / M O T I V A T I N G T H E C H I L D  Quotes in this category refer to: • Difficulties keeping the child engaged or motivated • Child not wanting to do things • Keeping intervention interesting/motivating for the child Note: quotes do NOT refer to the child's challenging behaviour—this belongs in the "ChallengingBehaviour" category  C A T E G O R Y 2: L A C K O F P R O G R E S S  Quotes in this category refer to: • The child not making any progress or improvement • The BI's feelings of helplessness or inadequacy with regards to helping the child • BI feeling like she is not making any difference  Experiences of Interventionists 155  C A T E G O R Y 3: C H A L L E N G I N G B E H A V I O U R  Quotes in this category refer to: • Dealing with/managing the child's challenging behaviour—the behaviour can manifest itself both emotionally (e.g., anger) and physically (e.g., tantrums, kicking) • The BI's response to the challenging behaviour (e.g., giving consequences, trying to stay calm) • Issues of non-compliance • Documenting or doing a functional analysis of the child's behaviour • Trying to determine the cause/function of the behaviour • Finding new ways to deal with challenging behaviour Note: quotes do NOT refer to the impact of challenging behaviour on the family, or the family's reaction to the challenging behaviour. This category is about the BI dealing with the behaviour. C A T E G O R Y 4: O T H E R / D O N ' T K N O W  Any quotations that refer to child variables but do not belong in the above 3 categories should be placed here. This includes quotations that are too vague to accurately categorize—that is, not enough information has been provided to enable you to accurately categorize the quote and place it into a specific subcategory.  FAMILY VARIABLES C A T E G O R Y 1: W O R K I N G IN A F A M I L Y ' S H O M E  Quotes in this category refer to: • Having to work in a family's home and dealing with issues related to working in this private environment, such as witnessing arguments/tension between parents, dealing with cultural/ value differences, and fitting in with the family's routines/lifestyle • BI trying to maintain professional boundaries with families—thus, any quote that talks about BI trying to establish or determine personal boundaries/space, parents seeing BI as a therapist/ counsellor, parents being dependent on the BI to support them and their child • Physical environment of the home (e.g., crowded space, materials not stored in a secure space)  C A T E G O R Y 2: C O N F L I C T / I N C O N S I S T E N C Y / L A C K O F S U P P O R T  Quotes in this category refer to: • Parents or family members not following through with program expectations or requirements—thus, the BI feels she is working hard but the gains are not maintained or are "undermined" outside intervention time • Poor communication with parents or family members • Lack of contact with parents or family members • Disagreement/conflict with parents or family members over issues such as intervention strategies being used, children being neglected, and beliefs/values/morals • BI not feeling valued/respected/ heard by parents or family members  Experiences of Interventionists\$()  •  Not working together as a team with parents or family members  C A T E G O R Y 3: F A M I L Y E X P E C T A T I O N S  Quotes in this category refer to: • Parents or family members having high or unrealistic expectations of the child and/or BI • Parents wanting a "cure" for autism, or wanting quick results from intervention C A T E G O R Y 4: O T H E R / D O N ' T K N O W  Any quotations that refer to family variables but do not belong in the above 3 categories should be placed here. This includes quotations that are too vague to accurately categorize—that is, not enough information has been provided to enable you to accurately categorize the quote and place it into a specific subcategory.  T E A M VARIABLES C O N F L I C T / I N C O N S I S T E N C Y / L A C K O F SUPPORT B E T W E E N T E A M M E M B E R S  Quotes in this category refer to: • Inadequate support/guidance/direction from other team members (e.g., SLPs, OTs) • Balancing the needs/interests of various team members, when there are different ideas, goals, philosophies, opinions, and work styles •  • •  Inconsistencies between team members/lack of consensus between team members Supervisory issues, such as poor communication with supervisors, inadequate support from supervisors, having more than one supervisor, and power differential between BI and supervisor •  • • • • • • • • •  Note: if the quote refers to trying meet the needs offamily and team members (e.g., supervisor), put in this category. If the quote refers only to the family, but not to other team members, then categorize it under Family Variables.  Note: if the quote refers to an issue specifically with a supervisor, put it in this category  Receiving conflicting messages from team members on how to perform tasks/work duties General conflict with colleagues (e.g., coworkers who are bossy, disrespectful, unprofessional) Having to work in collaboration with other team members Inadequate division of work responsibilities between team members General communication issues, such as BI not receiving enough information or getting answers to questions Difficulty contacting other team members Poor communication between BI and other team members (not including family) Unclear expectations Lack of recognition or appreciation from other team members (not including family) • If the quote does not refer to lack of appreciation/recognition by a specific team member (e.g., family or parent), it belongs here. That is, any general quotes about not feeling appreciated, valued, etc. belong here.  Experiences of Interventionists \ 57  JOB VARIABLES CATEGORY 1: ORGANIZATIONAL/AGENCY ISSUES  Quotes in this category refer to: • Physical environment/work space (e.g., crowded work space) • Bureaucracy/politics within the organization • Lack of training • Lack of opportunity for promotion • Inadequate pay/financial compensation • Inadequate supplies/resources • Having to do too much paper work or documentation • Poor or inadequate programs/program development CATEGORY 2: ISOLATION  Quotes in this category refer to: • Sense of isolation at work—the BI feels alone (lonely) and on her own when working . with the child • Limited contact with other team members; little opportunity to confide in other team members • Lack of support from other team members because of the job's isolated nature CATEGORY 3: TIME PRESSURE  Quotes in this category refer to: • Not having enough time to develop programs, achieve program goals, complete tasks, meet/debrief with coworkers • Note: Quotes referring to "not having enough time or opportunity to meet with coworkers" are categorized differently than "feeling isolated in the job." If the emphasis is lack of time/opportunity, then categorize it under "Time Pressure." If the emphasis is on feeling alone/isolated, categorize it under "Isolation." • Feeling rushed and having few breaks in the work day • Having to drive a lot, and having to get to other homes on time • Taking work home because there isn't enough time to complete tasks within scheduled work hours CATEGORY 4: JOB PERFORMANCE/JOB RESPONSIBILITY  Quotes in this category refer to: • General performance issues, such as learning to react/think quickly, being alert, being creative, coming up with new program ideas, trying to find new solutions to a problem • Learning to keep situations under control, as well as learning to keep oneself under control • Performing in front of people • Having work performance be evaluated • Being compared to other team members • Feeling responsible for the well being and success of the children and families in the program  Experiences of Interventionists\S%  •  Balancing and/or meeting the needs of the families, children, and the organization •  Note: If the quote refers to the program/agency in general terms and does not specifically mention issues with team members, include it here. Only include quotes that refer to more general performance issues. If the quote refers to issues with team members, categorize it under "Team Variables. "  CATEGORY 5: L E N G T H OF SESSIONS Quotes in this category refer to: • Working long shifts (3-5 hours) with a child and trying to keep the child learning for the duration of the shift •  The organization/agency ignoring needs of the child by scheduling long shifts  C A T E G O R Y 6: OTHER/DON'T KNOW Any quotations that refer to job variables but do not belong in the above 5 categories should be placed here. This includes quotations that are too vague to accurately categorize—that is, not enough information has been provided to enable you to accurately categorize the quote and place it into a specific subcategory.  Experiences oflnterventionists\^  Appendix Q Content Analysis for Additional Training and Support Needs of Bis  CATEGORY 1: INCREASED SUPERVISION, SUPPORT, AND RECOGNITION Participant # Quote 002 More support from senior staff when requested (i.e., O T coming to a child's session to demonstrate skills) 004 Somewhere or someone to debrief with, even when not facing challenging issues More double ups between [with?] team leaders....and senior staff 006 I'd love to hear more feedback about how kids are doing on assessment, so I know what areas are struggles and strengths 010 It would help to have on-site coaching versus video reviews (reviews which are sometimes too complimentary to be useful) More on-site supervision/support—we really are left quite alone to our own abilities/ideas 014 I would love the support of an O T or SLP 015 Support from supervisors, telling us we are doing a difficult job well Having supervisors help us deal with parent's unreasonable demands (i.e., working with the child when they are sick) 018 More video reviews Meetings with supervisors and clinical staff without parents present, or a logbook for clinical staff to read without parents being involved 020 I think that if the supervisors and clinical consultants doubled up or worked one shift a month, they would be better equipped with solutions that aren't out of a text book and see firsthand how difficult it can be to deal with behaviours. 023 Feedback from... .supervisors and other staff is always appreciated, even if negative 024 More feedback 025 Recognizing verbally [i.e., Verbal recognition] by the agency's figure heads. In the past years today was the first time I heard positive praise for employees as a whole that we are valued Monthly staff meeting and fun learning sessions as a whole agency when issues and a sense of community can be felt would be a way to find loyalty and provide staff with a place to find solutions for problems 028 More feedback More communication 030 Need supervision from boss Need regular communication with boss 032 Team meetings need to be closer together. It can be difficult to get in touch with supervisors when questions arise 033 More structured routine of what O T , SLP want to see when they are visiting the home 034 More recognition 035 I think that financially supported counselling services by [organization] for  Experiences  036 037 039 041 042 043  047 049 054 055  057 059  060 066  Total coded responses  ofInterventionistslftQ  interventionists would make a big difference Supervisors listening to us and valuing our input Regular evaluations by qualified, knowledgeable staff Regular feedback, whether it be constructive criticism or positive reinforcement Continuing education (more hands-on) from clinical team More performance reviews and observations from supervisors More opportunity to debrief and brainstorm with.. .therapists More opportunities to observe.. .therapists Have clinical staff or someone with intensive ABA background to attend sessions with me. I like getting feedback and new strategies that will help me with challenging behaviours More hands-on training by experienced behavioural analysts (behavioural consultants) More feedback from "someone higher with more experience and expertise" on our intervention techniques Regular feedback from supervisor Regular staff/info meetings I would like to have a better communication system developed to include everyone. I strongly believe that more support from OTs and SLPs is necessary to provide more effective intervention to the children. They need to come in and work with the children more often Our organization is starting to do monthly video reviews of sessions. I feel this really will be productive for many reasons. First, you can get some feedback on what you are doing, or how you are dealing with difficult situations. Second, it provides some staff time to discuss work, brainstorm, or just have a laugh at something cute. Increased staff meetings Feedback that comes back quicker (i.e., feedback on paperwork, data sheets) I feel that the support we receive in our agency is plenty, but often you need to seek it out yourself. If they don't know you're having a problem, they can't help Supervision (increased) and constructive criticism from more experienced staff members (initially) I think that our society does a good job of offering in-service meetings and trying to provide direction through consultations. However, it is difficult as a home-based therapist to get much observation and feedback to know how well I am doing on a day-to-day basis 44  Experiences  of Interventionists]^  CATEGORY 2: INCREASED CONTACT WITH Bis Participant # Quote 004 More double ups between.. .Bis 006 I would like to watch other Bis do sessions with kids. I've only ever seen one BI in a 2 hour session 008 Being able to observe more one-on-one therapy in progress 017 More time shadowing and seeing other Bis work 018 More opportunity to get together with other interventionists in a work setting (i.e., going on fieldtrips with the children together) 024 More interaction between other Bis to discuss work and socialize with others in thefield—oftenyou find yourself working only with the child and families but not with coworkers as much. More interaction and support would definitely help. 027 I feel I am getting a decent amount of support; maybe being able to see other interventionists work and get new ideas would help 038 Support group for interventionists 041 More opportunities to observe co-workers More observations from peers More opportunity to debrief and brainstorm with.. .coworkers 048 It would be helpful to have a specific forum for all the behaviour assistants of a house to share their experiences—without this we tend to be doing things slightly differently for some time before it is caught 049 I also think it would be very beneficial to have the opportunity to watch coworkers. Ideas and different methods help to regenerate me. 053 I understand and embrace the aspect of confidentiality, but perhaps we could have a social element of the job that allowed BAs to get together socially (without discussing in detail our kids) 054 Also, watching other team member's therapy sessions every once in a while would be very useful. We would be able to see what works/does not work for each person and give/get feedback 057 Watching other EITs with their children, since each child may. be so different—it's nice to see ideas and even prepare yourself when switches may occur 060 Increased job shadowing before working one-on-one with kid 065 Seeing videos of other people prior to doing therapy for the first time Total coded 18 responses C A T E G O R Y 3: TRAINING AND SUPPORT ON PARENTS/FAMILY ISSUES Participant # Quote 001 Conduct with children's families 012 Being given examples of how to handle situations—e.g., if a parent asks for a play date with the child you're working with. How is it to be handled? To know before the situation occurs. 018 Workshops dealing with specific topics (i.e., when you're in a family such as this....)  \  Experiences of Interventionists \ 62  022 023 031 035  036 038 041 044 046 067 Total coded responses  More parental support (i.e., stress management, IBI training) Feedback from family members How to handle family situations that arise while working in the home More training on how to deal with family issues would be great How to approach parents when dealing with difficult issues Family support group More opportunity to debrief and brainstorm with.. .parents More info on family centered practice More workshops on dealing with families More counselling strategies to effectively communicate with parents More parent involvement in child's therapy 14  C A T E G O R Y 4: CHANGES TO W O R K ENVIRONMENT/JOB/ORGANIZATIONAL VARIABLES Participant # Quote 004 More time to read recent research More time to meet as a team 010 It would be nice to have a training session on a weekday versus on a Saturday, in addition to a full week The office is way in the west of the city, too far to go for frequent visits/support 017 Better contact with the office Offer [training] sessions to current Bis to attend (paid) 019 We don't get sick days, so we go to work when we're sick. This can make for a very stressful day. It's harder to deal with behaviours when you feel awful to begin with (by the way, it's only the interventionists who don't get sick days, all other staff do) 022 More money 030 Need flexible training hours 037 More time to do all the things necessary to make each child's program as good as it could be 032 More training during the day rather than evenings. Can be too much to work all day and then go to training after that 039 Better work environment (office space) 043 More paid time devoted to education and further training (we're already taking day to day work home on or own time) 045 Time to debrief and get frustrations and anxieties out 062 More time to brainstorm with other team members—everyone's schedules are so tight Total coded 15 responses  Experiences  ofInterventionists\63  CATEGORY 5: TRAINING AND SKILL DEVELOPMENT IN SPECIFIC AREAS a) SLP Strategies Participant # Quote 006 SLP techniques 016 Understanding of basic steps taken to increase speech Writing of social stories 021 Speech 027 Also always feel in need of more knowledge in SLP area, not just PECS, more options and ideas 033 More training on speech issues—I feel like I am having the same few comments repeated over and over by SLPs as if they are talking down to me— I would like to be treated as a respected part of the team 038 Training in specific areas: speech/language 044 More info on SLP strategies 045 More workshops on areas such as SLP Ongoing sign language classes 049 I would greatly appreciate training around expanding language 050 More speech related information—like how to get the child to "say" it strategies 053 Sign language—I have a small vocab but I would like to be proficient Training in use of visual aids How to write a social story Total coded 15 responses b) OT Strategies Participant # Quote 006 OT techniques 021 OT 038 [training in] occupational therapy 044 [More info on] OT strategies 045 More workshops on areas such as OT 048 Some training in OT strategies would help me communicate better with the OT and make my application of her suggestions more successful. I went to a workshop by my own choice and it made a huge difference 056 [More access to specializationfieldsin]...strictly sensory environments 063 Sensory issues—it seems to be something not often talked about (e.g., causes, seeking behaviours, therapeutic treatment) Total coded 8 responses c) Behaviour management Participant # Quote 006 Behaviour management 007 More challenging behaviour workshops  Experiences ofInterventionists\S4  019 031 036 045 049 053 Total coded responses  We need crisis training. The child I work with has meltdowns and loses control and the organization has never taught us how to deal with those situations. It's very stressful and frightening. Dealing with aggressive attacks from children (restraint ) Being able to deal with difficult/challenging behaviours in different ways Non violent crisis intervention Continued ideas on proactive behaviour management and aggressive behaviour management .. .more ways to deal with challenging behaviour A course in FAB would be excellent so I could be more accurate in discovering triggers of maladaptive behaviour More ideas on redirection of aggression 10  d) Teaching strategies/therapy Participant # Quote 013 Refreshing NTS [Natural Teaching Strategies] skills 021 NTS [Natural Teaching Strategies] training 045 More discrete trial training 050 Any type of play therapy—you can never have enough ideas 056 This field requires more access to specialization fields in music therapy, play therapy... (therefore, greater community awareness and funding growth is needed) 058 More info regarding different types and techniques used in therapy (I believe an eclectic approach is more effective) Total coded responses  6  e) Organizational structure/policy/philosophy Participant # Quote 032 More understanding of how the organization works (board, LAC, etc) 060 Familiarization with organization's guidelines, methodologies and beliefs regarding family relation, behaviour therapy, etc. 062 Opportunities to volunteer/work various positions—learn more about other departments Total coded responses  3  f) Written materials/resources/current research/best practice Participant # Quote 006 Consistent review of best practice.. .and current research 009 Ongoing training on newest research 010 The office/boss/organization brags that it has a resource library, but one has to practically beg to take a book/resource home to study. The items available are  Experiences  017 Total coded responses  of Interventionists  less than 50 books. I'd appreciate much more access to more materials. Being updated with new research More written materials to read on various types of intervention strategies 5  g) Activity ideas/program ideas Participant # Quote 030 Need activity ideas 045 Workshops on art activities, songs, cooperative games 051 Ideas to make table programs more enjoyable 064 Working on different strategies to employ with kids, as well as new ideas to incorporate into daily schedule Total coded responses  4  h) Data keeping/data collection Participant # 001 Data keeping 045 More data taking seminars 065 How to do data sheets Total coded responses  Quote  3  i) Other job training Participant # Quote 001 Bi-monthly reviews on the training material 003 Considering I had very little training, I would have liked to have a more structured training plan set out. I was given.a binder and a few double-ups and then was on my own. It was very stressful! "Learning by doing" is very important, but there needs to be more to supplement this. I feel that I pretty much was not adequately changed [trained?]. It almost seems that it puts you at a disadvantage compared to those who received training. 016 Understanding of the curriculum used and the order in which it should be done 017 Kept informed of changes to training curriculum 030 Any type of training for on-the-job tasks Review 031 Stress management 033 More on-the-job training 038 [Training in] psychological tests 040 More choices of training better suited to child's needs 046 More training on supporting these children effectively....and interpersonal relationships with coworkers 047 Information on how to answer questions directed to me about children with autism in general from school/preschool  165  Experiences  048  of Interventionists]  067  No specific training was given for administrative type tasks—that would have been helpful and saved a lot of confusion A more concise guide to our table programs, laid out step by step, available to keep and study Computer training so I can be more independent with compiling materials Increased training would be helpful Having an organized booklet of information about aspects of the job and daily requirements (e.g., target goals, decide goals, etc.) More exposure to different clients and different programs  Total coded responses  18  050 053 055 065  j) General workshops/conferences/in-services/professional development Participant # Quote 001 Ability to go to more workshops or have an increased amount of inservice/workshops 004 More conferences 017 More workshops/PD days 018 Occasional workshops dealing with specific topics (i.e., if your child does ) 024 More seminars and professional development days 028 Mini workshops 029 More workshops/PD days More different workshops to access 037 Ongoing workshops in areas that I feel my skills need improving, developing, or just refreshing 040 More workshops available More in-depth info 055 Increased conferencing 059 I guess my attending any type of workshops or classes related to this field. But I do have a lot of training already. We learn a lot from our consulting team on a weekly basis when they come to the home to work with the child when we are there 062 Opportunities to attend conferences/external seminars. As "front line" staff, we rarely have the opportunity Total coded responses  14  C A T E G O R Y 6: O T H E R / D O N ' T K N O W  Participant # 038 039 049  Quote Consistency in paperwork More therapeutic intervention independent of interventionist or co-teaming Consistency as much as possible.  Total coded responses  3  66  Experiences of Interventionists \ 67  Total number of coded responses: 180  SUPERVISION/SUPPORT CONTACT WITH Bis F A M I L Y VARIABLES JOB VARIABLES TRAINING & SKILL DEV'T OTHER TOTAL  # OF RESPONSES  % OF TOTAL  44/180 18/180 14/180 15/180 86/180 3/180 180/180  24% 10% 8% 8% 48% 2% 100%  RANK 2 3 5 4 1 6  Experiences of Interventionists]^  Appendix R Code Book for Additional Training and Support Needs of Bis  Quotes will fall under 1 of 6 categories: 1) 2) 3) 4) 5) 6)  Increased supervision and support Increased contact with Bis Training and support re: parents/family issues Changes to work environment/job/organization variables Training and skill development in specific areas Other/don't know  For Category 5 (Training and skill development in specific areas), there are 10 subcategories. Thus, you will need to determine which one of the subcategories the quotations belongs in, based on the criteria outlined in the following pages. Remember that one sentence may contain more than one concept and therefore belong in more than one category. This happens occasionally,.but is not common. Be sure to read the content of the sentence and determine whether it deals with only one category, or more than one category. If the quote refers to more than one category, break it down into its smaller parts and categorize each of the parts separately. C A T E G O R Y 1: INCREASED SUPERVISION AND SUPPORT Quotes in this category refer to: • Wanting increased support and supervision from senior staff members/clinical team (e.g., OT, SLP, Psychologist, supervisors, behaviour analyst/consultant) - this includes "hands on" support and on-site supervision provided to the BI •  • • • • • • •  Note: If the quote just states "OT" or "SLP " but does not clearly state that the person desires the support of an actual OT or SLP (i.e., the person), it belongs in Category 5  Getting feedback/support from someone with more experience or expertise Video reviews Recognition/praise from other staff members Being evaluated by staff members Improving communication between team members Increased meetings with team members Counselling services for Bis  Note: Any quotes that refer to issues with supervisors or bosses belong here. If the quote refers to issues between supervisors and other team members (e.g., BI, parent), it still belongs here. Note: Any quotes that refer to working or having increased contact with Bis belong in Category  Experiences of lnterventionists\(Q  C A T E G O R Y 2: I N C R E A S E D C O N T A C T W I T H Bis  Quotes in this category refer to: Observing/watching Bis work with a child Other Bis demonstrating skills to the BI Doubling up with or shadowing other Bis Watching videos of Bis working with a child Support groups for Bis Increased interaction/contact with Bis (e.g., going on fieldtrips with other Bis) Sharing experiences with other Bis (this does not include counselling services) Any quotes that refer to working with and having contact with Bis belong here If the quote refers to peers or coworkers, it belongs in this category If the quote refers to "observing team members," but does not specifically refer to senior staff or professionals (e.g., OTs, SLPs), it belongs in this category. That is, if it is not clear that the quote is in fact referring to anyone other than a BI, assume it is referring to the BI and categorize it here.  C A T E G O R Y 3: T R A I N I N G A N D S U P P O R T R E : P A R E N T S / F A M I L Y ISSUES  Quotes in this category refer to: • Dealing with or managing issues that involve parents or the family • Increased support for families (e.g., support group) • Increased training for families • General strategies or workshops on how to deal with parents/family • Improving communication with parents/family • Family centered practice C A T E G O R Y 4: C H A N G E S T O W O R K E N V I R O N M E N T / J O B / O R G A N I Z A T I O N A L VARIABLES  Quotes in this category refer to: • Wanting more time to do work-related tasks such as attend meetings or conferences, or meet with team members (Note: if the emphasis is on not having enough time or time pressure, it belongs here)  • • • • • •  Being paid more money in general Being paid for sick days Being paid for work related tasks such as training Changing dates and times of training sessions to accommodate Bis (e.g., having training on the weekend instead of a weekday) Lack of contact with office; difficulty accessing office or office staff Physical work environment/office space  Experiences of Interventionists\JQ  C A T E G O R Y 5: T R A I N I N G A N D S K I L L D E V E L O P M E N T I N S P E C I F I C A R E A S  Quotes in this category belong under 1 of 10 subcategories: a) SLP/Communication Issues: • Quotes that refer specifically to wanting more training in SLP issues, including increasing or expanding language/speech, PECS, sign language, visual supports and social stories • If the quote refers to wanting more information/training on SLP strategies but does not list any specific strategies, it belongs here b) OT/Sensory Issues: • Quotes that refer specifically to wanting more training in OT issues, including sensory issues • If the quote refers to wanting more information/training on OT strategies but does not list any specific strategies, it belongs here c) Behaviour management • Quotes that refer to wanting more training or information on how to manage or deal with challenging behaviour, including behaviour management strategies, crisis intervention, managing aggression d) Teaching strategies/therapy • Quotes that refer to wanting more training or information on specific teaching strategies, including Natural Teaching Strategies (NTS) and discrete trial teaching • Quotes that refer to wanting more information about different types of therapy, including play therapy and music therapy • Note: If the quote refers to therapy in general, but does not list a specific type of therapy, it belongs here e) Organizational structure/policy/philosophy • Quotes that refer to wanting more training or information on the organization or agency, including organizational structure, guidelines, philosophy • Quotes that refer to wanting to learn about other positions or departments within the organization f) Reading materials/resources/current research/best practice • Quotes that refer to wanting increased access to written materials or resources • Quotes that refer to wanting more information or training on current research or best practices g) Activity ideas/program ideas • Quotes that refer to wanting more activity ideas or program ideas, including the areas of songs and games  Experiences of Interventionists 171  •  General quotes that refer to wanting more ideas to make programs or therapy more fun/interesting for the child General quotes that refer to wanting new ideas to use in programs or new strategies to use with kids belongs here  •  h) Data keeping/data collection • Quotes that refer to wanting more information or training on how to take data or keep records i) Other job training • Quotes that refer to wanting more training for job issues such as programming and curriculum • Quotes that refer to wanting more review in general • Quotes that refer to wanting more information about job requirements and how to do the job • Quotes that refer to wanting to learn about other kids and other programs • Quotes that refer to general issues regarding on-the-job training that do not belong in one of the above categories • Any quotes that refer to specific training issues but do not belong in one of the above categories (e.g., training on psychological tests—does not belong in any of the other categories, so it would be included here) •  Note: if the quote talks about "training, " check first to see if it will fit into any one of the other specific training categories. If it doesn't, put it in this category.  j) General workshops/conferences/in-services/professional development • Quotes that refer to wanting increased workshops, in-services, conferences, and professional development in general, and that do not belong in one of the above categories • Quotes that refer to workshops on specific topics do not belong here—only include quotes that refer to wanting workshops, in-services, etc. in general •  Note: if the quote talks about "workshops or conferences or professional development, " check first to see if it will fit into any one of the other specific categories. If it doesn't, put it in this category.  C A T E G O R Y 6: OTHER/DON'T KNOW Any quotations that do not belong in the above 5 categories should be placed here. This includes quotations that are too vague to accurately categorize—that is, not enough information has been provided to enable you to accurately categorize the quote.  

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