Date of Award


Document Type


Degree Name


Organizational Unit

Morgridge College of Education, Teaching and Learning Sciences, Curriculum and Instruction

First Advisor

Gloria Miller

Second Advisor

Phillip S. Strain

Third Advisor

Garrett Roberts

Fourth Advisor

Sarah Watamura


Behavior, Caregiver, Challenging behavior, Function based assessment, Telehealth


As children advance through developmental stages, they often present behavioral difficulties such as tantrums, lack of cooperation, and aggression. For some children, behaviors are serious enough that they interfere with the child’s ability to engage in positive relationships, participate in necessary routines, and learn new skills, warranting behavioral intervention (Dunlap et al., 2017). Being responsive to the needs of the family and appreciation for the central role that they play is crucial to the success of behavioral interventions and the maintenance of positive outcomes (Bailey, 2013; Campbell, 1995), thus, their input should be at the center of all recommendations and assistance. There is ample evidence to suggest that providers are limited in their capacity to provide evidence based behavioral intervention (Dunlap & Fox, 2011). Further, in light of the Covid-19 pandemic, children are receiving a reduced dosage of evidence- based practices. Telehealth has been offered as a platform that caregivers can access coaching on a variety of strategies pertaining to social emotional development of their young children and shown positive outcomes (Shieltz and Wacker, 2020).

The purpose of this study is to better understand the existing literature base on current telehealth practices providing support to caregivers of individuals exhibiting challenging behavior. A systematic and quality review of the literature was conducted and reported on training components, procedural fidelity, social validity, and evidence of impact of studies that met the inclusion criteria. While there exists a great deal of information on remote implementation of interventions for challenging behavior, gaps remain pertaining to systematic replicable coaching methods and the emphasis of social validity throughout the treatment process. Therefore, the experimental study pertains to the development and testing of remote facilitation of Prevent Teach Reinforce for Families (PTR-F:R) to address the challenging behavior of young children in home settings.

A single case multiple baseline design was used across five families with children between the ages of 2 and 5. Data was collected on the feasibility, usability, and acceptability of the process. Child outcomes such as percentage of intervals with challenging behavior (CB) and use of social skills using rating forms before and after PTR-F:R as well as caregiver outcomes such as stress levels and sense of competence were measured. Data were analyzed using visual analysis to assess the trend, variability, and immediacy of the effect of PTR-F:R on child challenging behavior across baseline and intervention phases. Repeated measures of parenting stress, parenting sense of competence, and child social skills were analyzed. All results were considered in light of fidelity measures, both caregiver implementation fidelity of the behavior support plan as written as part of the PTR-F:R process, as well as fidelity of remote implementation of facilitation of the PTR-F:R process, both recorded as percentage of steps completed each visit. Social validity ratings regarding the PTR-F:R process and the intervention plans developed and implemented during the participant’s participation further indicated the extent of success of the process delivered in this new and different format. This study expands the research on both PTR-F as well as caregiver led function-based interventions for challenging behavior. Results, study limitations, recommendations for future research, and implications for practice are discussed.

Publication Statement

Copyright is held by the author. User is responsible for all copyright compliance.

Rights Holder

Abby Hodges


Received from ProQuest

File Format




File Size

113 pgs


Behavioral psychology, Psychology, School counseling