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Using Acceptance and Commitment Training and a virtual patient model for supporting families with children with autism spectrum disorder

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Using Acceptance and Commitment Training and a virtual patient model for supporting families with children with autism spectrum disorder

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Content USING ACT AND A VIRTUAL PATIENT MODEL FOR FAMILY SUPPORT

Using Acceptance and Commitment Training and a Virtual Patient Model for Supporting
Families with Children with Autism Spectrum Disorder

By

Meri Varuzhevna Yedigaryan

A Thesis Presented to the
FACULTY OF THE USC DANA AND DAVID DORNSIFE
COLLEGE OF LETTERS, ARTS, AND SCIENCES
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTER OF SCIENCE
(APPLIED BEHAVIOR ANALYSIS)

August 2023

Copyright 2023 Meri Varuzhevna Yedigaryan
USING ACT AND A VIRTUAL PATIENT MODEL FOR FAMILY SUPPORT
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Acknowledgments
I am deeply grateful to my esteemed advisors, Dr. Michael Cameron and Dr. Jonathan Tarbox
for their invaluable guidance and unwavering support throughout my research. Their expertise,
feedback, and insightful suggestions have shaped the direction and quality of my research.

I extend my heartfelt appreciation to my family for their love and encouragement. To my
parents, Luiza and Varuzh, thank you for your constant belief in my abilities and the sacrifices
you have made. I am forever grateful for your consistent support.

I would like to express my sincere thanks to the research participants who generously shared
their time and experiences. Their contributions have greatly enriched the field of Applied
Behavior Analysis.

Thank you all for being part of this important milestone in my academic and personal growth.

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Table of Contents
Acknowledgements ........................................................................................................................ ii
List of Tables .................................................................................................................................. v
List of Figures ................................................................................................................................ vi
Abstract ........................................................................................................................................ vii
Chapter 1: Introduction ................................................................................................................... 1
Chapter 2: Methods ......................................................................................................................... 5
Participants ………................................................................................................. 5
Setting ……............................................................................................................. 6
Design ……............................................................................................................. 6
Chapter 3: Variables
Independent Variables ............................................................................................ 7
Values Clarification.………........................................................................ 7
Virtual Patient Model …….......................................................................... 7
Dependent Variables ............................................................................................... 7
Improved Goals and Objectives ………...................................................... 7
Utilization of Family Guidance ………………........................................... 7
Social Validity ………................................................................................ 8
Chapter 4: Procedures …………..................................................................................................... 8
Chapter 5: Results ………………................................................................................................. 10
Erik’s Family ……................................................................................................ 10
Adam’s Family …................................................................................................. 11
Chapter 6: Discussion …………................................................................................................... 12
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References ………….................................................................................................................... 15
Appendices …………................................................................................................................... 18
Appendix A: Erik’s Family’s Treatment Plan Ratings .......................................... 18
Appendix B: Erik’s BCBA’s Treatment Plan Ratings .......................................... 18
Appendix C: Adam’s Family’s Treatment Plan Ratings ....................................... 19
Appendix D: Adam’s Clinical Supervisor’s Treatment Plan Ratings …............... 19
Appendix E: Erik’s Family’s Social Validity Ratings ........................................... 20
Appendix F: Erik’s BCBA’s Social Validity Ratings ........................................... 20
Appendix G: Adam’s Family’s Social Validity Ratings ....................................... 21
Appendix H: Adam’s Clinical Supervisors Social Validity Ratings ..................... 21
Appendix I: Erik’s Family’s Percent of Monthly Hours Utilized ........................ 22
Appendix J: Adam’s Family’s Percent of Monthly Hours Utilized .................... 22
Appendix K: Clinician’s Quality Assessment Rubric ……................................... 23
Appendix L: Family’s Quality Assessment Rubric ……....................................... 27
Appendix M: Clinician’s Social Validity Questionnaire ……............................... 32
Appendix N: Family’s Social Validity Questionnaire ……................................... 33
Appendix O: Virtual Patient Video Steps ……...................................................... 34

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List of Tables

Erik’s Family’s Treatment Plan Ratings ....................................................................................... 18
Erik’s BCBA’s Treatment Plan Ratings ....................................................................................... 18
Adam’s Family’s Treatment Plan Ratings .................................................................................... 19
Adam’s Clinical Supervisor’s Treatment Plan Ratings ................................................................. 19
Erik’s Family’s Social Validity Ratings ........................................................................................ 20
Erik’s BCBA’s Social Validity Ratings ........................................................................................ 20
Adam’s Family’s Social Validity Ratings ..................................................................................... 21
Adam’s Clinical Supervisors Social Validity Ratings ................................................................... 21

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List of Figures

Erik’s Family’s Percent of Monthly Hours Utilized .................................................................... 22
Adam’s Family’s Percent of Monthly Hours Utilized ................................................................. 22

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Abstract
A stage-based protocol was used to support Board Certified Behavior Analysts (BCBAs)
and clinicians in their efforts to increase the level of engagement of families of children with
autism spectrum disorder. The first step was identifying the family values. Thereafter,
researchers identified the goals, procedures, and objectives of the treatment in order to create a
socially valid protocol. A “virtual patient” model was utilized. In this model, parents developed a
video to elucidate their values, which served as a guide for client care. Board Certified Behavior
Analysts assessed the video and created a family guidance protocol that mirrored the family’s
needs. Lastly, families and clinicians rated the family’s treatment plan and the extent to which
they felt included in the process. The efficacy of the intervention was evaluated based on the
following: a) the quality of the treatment plans (i.e., pre- and post-intervention) evaluated against
an analytic rubric, b) the clinical team’s utilization of scheduled family guidance hours (i.e.,
baseline data was compared to post-intervention data), and c) the social validity of the treatment
plan was assessed by both families and clinicians.
Keywords: Applied Behavior Analysis; Acceptance and Commitment Training; family
guidance; parent training; video-based values clarification; virtual patient model

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Using Acceptance and Commitment Training and a Virtual Patient Model for Supporting
Families with Children with Autism Spectrum Disorder
Chapter 1: Introduction
The method of teaching in many Applied Behavior Analysis (ABA) graduate programs is
focused on discipline-based education. Similar to medical school curricula, students receive
education on the basics of science, which is later combined with the clinical aspect during
practicum training. As Quintero et al. (2016) discuss in their article, the discipline-based
approach may result in students not connecting the applicability of the science to its clinical uses.
Therefore, implementing an integrated approach may result in better qualified professionals, as
students learn the basics of ABA in the context of its clinical application. For example, in the
field of ABA, many clinicians and Board Certified Behavior Analysts (BCBAs) work with
families to support their clients. Oftentimes, while learning the basic principles of ABA,
clinicians do not receive training on how to directly assist families or those related to the client.
The discord between integrating the basics of ABA and its application in the field, results in less
prepared professionals. Moreover, the sequence of learning the basic principles first, and
subsequently, the application of the science, results in the de-emphasizing of one of the seven
dimensions of behavior analysis (i.e., applied). Consequently, a model of training, comparable to
the Integrated Medical Model, must be adopted. Furthermore, methods for working effectively
with families must be identified and emphasized throughout the duration of a clinician’s training
program.
When families with children with autism spectrum disorder (ASD) receive ABA therapy,
parents and clinical teams are expected to participate in family guidance training by insurers
(Symon, 2005). According to the National Standards Report, parent-implemented interventions,
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which is an evidence-based practice, promote social communication, while decreasing
challenging behaviors (Hendricks, 2009; Steinbrenner et al, 2020). Family guidance sessions are
aimed at providing a basis and understanding of what actions families can take to support their
child when behavior interventionists (Registered Behavior Technicians) are not present. The
number of hours a family is awarded by an insurance company for the purpose of receiving
family guidance is typically underutilized. The underutilization results in families not being
supplied with the learning opportunities needed to help their children.
In the field of behavior analysis, research has focused on many aspects of family
guidance, but has failed to consider the relationship between BCBA preparedness and the
implementation of family guidance. An article described how researchers found that family
dissatisfaction with the behavior analyst working with their family often arose from inadequate
relationship skills (Taylor et al., 2018). Although families require the support of BCBAs, the
existing academic and professional training often neglects to include relationship-building
techniques, which may cause clinicians to feel less confident when providing family guidance.
Academic programs provide highly technical training in behavior terminology and core concepts,
but often fail to incorporate training in rapport building and working with families. Pastrana et al.
(2016) gathered a series of popular assigned readings used in behavior analysis graduate training
programs. They found that none of the articles precisely addressed the rapport-building skills that
are necessary to effectively work with families. Therefore, many practitioners may enter the field
of ABA lacking the skill and competence to assist clients and their families equally.
As COVID-19 continues to spread, many ABA providers have turned to telehealth when
providing services. A recent article provided a detailed guide on how to develop a telehealth
ABA parent training (i.e., family guidance) program (Yi & Dixon, 2020). This approach found
USING ACT AND A VIRTUAL PATIENT MODEL FOR FAMILY SUPPORT
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that using Acceptance and Commitment Training (ACT) and non-behavior-analytic terms
supported the effectiveness of parental adherence. Yi and Dixon’s recommendations highlight
not only the importance of using ACT in conjunction with family guidance, but also the
flexibility that telehealth sessions provide in performing these services. Additionally, earlier
conducted research supports the notion that telehealth is an adequate method for behavioral
support and family guidance sessions. In a systematic review by Ferguson et al. (2019),
researchers analyzed 28 studies that used telehealth to conduct behavioral assessments,
behavioral support sessions, as well as family guidance, finding compelling evidence for its
effectiveness. In fact, Cameron et al. (2020) suggests a five-step protocol that clinical teams can
utilize to structure telehealth sessions. By prioritizing family values and parent-led programming,
Cameron et al. found that telehealth optimized family engagement.
Acceptance and Commitment Training (Hayes et al, 2003) is a mindfulness-based
therapy used to assist behavior change that combines a wide range of experiential exercises and
values-guided behavioral interventions (Barnes-Holmes et al., 2002; Harris, 2006). ACT
supports individuals in establishing psychological flexibility to achieve valued ends (Blackledge
& Drake, 2013). Acceptance and Commitment Training incorporates values, committed action,
the present moment, and a series of other processes to achieve psychological flexibility (Coyne,
McHugh, & Martinez, 2011). Acceptance and Commitment Training has proven to be useful in
aiding a series of clinical conditions, including ASD. It has been previously used to assist
families with children with ASD (Blackledge & Hayes, 2006). Blackledge and Hayes assessed
the impact of a two-day ACT workshop on parents of children with autism and discovered
reductions in parental stress and depression. Additionally, Evelyn Gould, Jonathan Tarbox, and
Lisa Coyn analyzed the effects of ACT on parents’ values-directed overt behavior. They found
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that ACT increased these behaviors and maintained them over six months post-training (Gould et
al, 2018).
In this study, we incorporate the “virtual patient” model from the medical field to help
families create a video-based appeal directed to the clinical team. The term “virtual patient”
refers to “a specific type of computer-based program that simulates real-life clinical scenarios;
learners emulate the roles of health care providers to obtain a history, conduct a physical exam,
and make diagnostic and therapeutic decisions” (American Association of Medical Colleges,
2009, p. 7). The “virtual patient” model is a novel contribution to the field of ABA, but it has
been used widely across the medical field in training medical professionals. Pantziaras et al.
(2015) found that virtual patients can successfully acquire essential knowledge in the field of
psychiatry. In fact, resident psychiatrists were able to develop the key skills required when
working with patients. The authors suggest that repeated training sessions with virtual patients
will be effective in achieving sustainable educational results. The virtual patient model will
provide sufficient guidance in the clinical environment for BCBAs (Edelbring et al, 2011). It
may help encourage clinical reasoning and support effective decision-making. Emotional
interactivity will not be sacrificed because BCBAs will have the ability to interact with the
family and follow up. In an effort to emphasize clinical practice and application, and
concurrently support BCBAs learning about the appropriate formulation of goals and objectives,
a virtual patient model can be used. This model may be effective in the field of ABA as it
pertains to this study because the video-based appeal will consist of the family’s articulation of
goals and values that are meaningful to them. The clinical team can refer back to the video-based
appeal when creating programming for the child and family.

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The video-based appeal may also serve as an important training opportunity as the
clinical team expands. The clinical team can use the video when training new team members, or
if there are changes to the client’s clinical team (Deladisma et al, 2007). Unlike training in the
medical field, the clinical team can always communicate with the actual patient if clarification is
necessary. To understand the complete history and family dynamic, the clinical team can always
follow up with the family. Virtual patients will always be conjoined with an actual family,
allowing the family unit to be utilized as a collaborative teaching tool.
The purpose of this study was to evaluate the impact of using an ACT-based workshop
alongside the “virtual patient” intervention to improve the quality of family guidance goals and
objectives, the utilization of family guidance hours, and the social validity of clinical procedures,
goals, and outcomes produced by the clincians.
Chapter 2: Method
Participants
This study focused on two families with children of different ages. The participants were
recruited by the researchers presenting flyers to two different autism service companies and
clinical supervisors presenting the study to parents.
The first participants were a family of five, including Erik, a 12-year-old boy living in
Connecticut with his sister, parents, and grandmother. Erik was born a fraternal twin and was
diagnosed with autism spectrum disorder at 3.5 years old. Erik’s parents, Lauren and Matthew,
attended scheduled family guidance sessions inconsistently due to arising family issues (e.g.,
health concerns and family emergencies). As part of their service agreement, they were awarded
two hours of family guidance per month through the commercial payor for services. They used
hybrid (teleconsultation and in-person, center-based) family guidance support.
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The second participant was a five-year-old boy named Adam, who was adopted and
living in California with a non-biological sister who was also adopted. Adam was adopted when
he was 2 months old. His parents, Lucy and Carl, attended family guidance sessions as
consistently as possible, but sessions were canceled due to health concerns and scheduling
inconsistencies. The family has a history of not receiving family guidance as a result of
competing clinical responsibilities on behalf of the family. As a part of their service agreement,
they were awarded two hours of family guidance per month through the regional center for
services. They used a hybrid (teleconsultation and in-person, home-based) family guidance
support.
Setting
The study used a video-based method, allowing families to participate from the comfort
of their homes via telehealth. A HIPAA-compliant platform, Zoom, was utilized. Prior to the
study, researchers ensured that the families had access to appropriate connectivity and broadband
capabilities.
Design
The study used a non-concurrent multiple baseline experimental approach across
families. Baseline data was collected from two qualifying families for the completed research
study. Data on the utilization of family guidance hours before the intervention was recorded. The
families and clinical supervisors participated in a social validity interview, rating their current
family guidance sessions on a five-point Likert scale. In addition to the interview, the family
guidance goals and objectives were subject to a quality evaluation based on a rubric analyzing
seven core standards.
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Chapter 3: Variables
Independent Variables
Values Clarification. The first independent variable was the ACT workshop, which
focused on a values clarification exercise. Families were guided through a values-based
clarification exercise during which they organized the services that were most important to them.
Researchers used ACT exercises, such as the Bull's Eye, created by Tobias Lundgren et al.
(2021), to assess the families’ values and committed actions.
Virtual Patient Model. The second independent variable is the “virtual patient” model,
which includes the video-based appeal. The families created a video appeal outlining their major
objectives and goals. The overview by the family members was directly influenced by the values
established during the ACT workshop. All members of the client’s family were included in the
video-based appeal, including parents, grandparents, and siblings. This helped incorporate the
values and objectives of all family members equally.
Dependent Variables
Improved Goals and Objectives. A rubric was created to evaluate the quality of family
guidance goals and objectives based on seven core standards (strength-based skills, behavior
excesses, skills targeted, progression monitoring, overall goals and objectives, interprofessional
collaboration, and communication). The rubric assessed the clinical supervisor’s engagement
with the video-based appeal and how it can be applied to future programming. Baseline data was
gathered to understand if the family was previously consulted when programming was created,
and compared to the post-assessment survey. The rubric was rated on a three-point Likert scale
(0 = poor, 1 = suboptimal, 2 = optimal).
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Utilization of Family Guidance. The utilization of authorized hours was assessed by a
comparison of the baseline versus the post-intervention use of hours.
Social Validity. A social validity survey was used in the study. A all participants were
asked to rate the study’s procedures and goals on a scale of 1-5, with 1 being “strongly disagree,”
and 5 being “strongly agree.” There are a total of 11 questions in this survey. This assessment
was conducted both before and after the intervention in order to assess whether there was a
positive change in social validity.
Chapter 4: Procedures
A stage-based model was created to assist clinicians in providing support to children with
autism spectrum disorders and their families.
Step 1
The researchers collected baseline data on family guidance utilization. Using a specified
rubric, they evaluated the process of developing the treatment plan. Both clinicians and families
were asked to report whether the family was consulted when family guidance programming was
created. Clinical supervisors and families were asked to partake in a pre-intervention social
validity interview.
Step 2
Next, researchers conducted a one-hour Acceptance and Commitment Training (ACT)
workshop to identify the family member’s values. This helped assess the most meaningful goals
and outcomes for the family. Families were asked to participate in the “Bull’s Eye” values
clarification exercise guided by the researchers.
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Step 3
Based on the “Bull’s Eye” exercise, the researchers identified the goals and objectives of
the treatment, based on family values, in order to develop a stage-based intervention.
Step 4
A “virtual patient” method was used where families created a values-based clarification
video based on previously outlined goals and objectives. This video was used as a tool to
concisely represent the family’s most meaningful objectives.
Step 5
Subsequently, clinical supervisors assessed the video and created a family guidance
protocol that mirrored the family’s values and goals. The clinical supervisors were asked to
connect programs to the different values directly mentioned by the family in the client’s
programming.
Step 6
Researchers gathered post-intervention data on the utilization of family guidance by
families and clinicians.
Step 7
Researchers measured family and clinical supervisor engagement through the utilization
of authorized and scheduled family guidance hours. Specifically, family engagement was
verified through the use of family guidance hours. Both clinicians and families were asked to
report post-intervention data on social validity and rate the new and improved family guidance
goals and objectives.
This stage-based model investigated the use of ACT and the virtual patient model. Once
the data was analyzed and interpreted, the results provided novel insight into the impact of ACT
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and the virtual patient model, with regard to the quality of family guidance goals and objectives,
utilization of family guidance hours, and social validity.
Chapter 5: Results
The aim of this study was to observe positive impact on several key aspects:
1. The quality of family guidance goals and objectives set forth by clinicians;
2. The utilization rate of family guidance hours;
3. Changes in the social validity of clinical procedures, goals, and outcomes.
The results for each participant are outlined below.
Erik. Erik’s family demonstrated great overall increase with the dependent variables.
From Erik’s family’s perspective, the quality of the treatment plan scores increased by 450%
from two points to 11 points; for the BCBA, scores increased by 100% from six points to 12
points (see Tables 1 and 2). Erik’s family’s baseline utilization of hours averaged about 13.8%.
In the post-assessment, there was an overall increase in the utilization of family guidance hours
during the first month of intervention, which later decreased during the second and third months
of intervention due to scheduling issues on behalf of the BCBA. While considering these
variables, the average utilization increased to 75% post-intervention. The Percentage of Non-
Overlapping Data (PND) for Erik’s family was 50%. As long as the independent variable was in
place, the family was responsive; but once there was the added variable of BCBA scheduling, we
saw a decrease in utilization (see Graph 1). It is important to note that cancellations were made
by the BCBA, and the family attended all scheduled meetings. Overall, social validity increased
both for the parents and the BCBA. Social validity increased for both the family and the BCBA,
with the family’s score increasing by 30% from 36 points to 47 points (out of 50 points); the
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BCBA’s score increased by 21% from 28 points to 34 points (out of 40 points) (see Tables 5 and
6).
Adam. Adam’s family showed promising results, not only with improved goals and
objectives but also a complete utilization of monthly family guidance hours. There were also
significant increases in social validity scores for parents and the clinical supervisor. Based on the
amended family guidance goals, there was an increase in the scores of the family treatment plan.
Out of a maximum of 14 points, the family’s baseline was seven points, which increased 85% to
13 points; the clinical supervisor's baseline was four points, which increased 200% to 12 points
(See Tables 3 and 4). In baseline, utilization ranged between 0% to 50%, averaging about 21.5%,
but as a result of the subsequent ACT workshop, utilization increased to 100% and was
maintained across three months. The PND for Adam’s family was 100% (See Graph 2).
Additionally, there was an increase in the social validity scores for both the family and the
clinical supervisor. Out of a total ceiling score of 50 points, the baseline was 31 points, but post-
intervention it increased to 47 points for the family, which is a 51.6% increase (see Table 7). For
Adam’s clinical supervisor, out of a ceiling of 40 points, the baseline was 14 points and
increased to 37 points, totaling a 164% increase (see Table 8). Adam’s family and clinical
supervisor had an overall increase in the targeted dependent variables.
As a result of the independent variables, there was an increase in the use of scheduled
family guidance hours for both participating families. Adam’s family and assigned clinical
supervisor successfully scheduled and attended all family guidance sessions (see Graph 1). In
terms of utilization for Erik’s family, it was reported that the BCBA assigned to the family’s case
failed to schedule additional meetings during the months of January and February due to
scheduling mishaps (see Graph 2).
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Chapter 6: Discussion
When providing ABA treatment, clinicians are not only treating the client but also their
family. The use of an ACT-based intervention by clinicians when working with families is
incredibly important. It is an affirming process for families, who may not have had the
opportunity to explore and identify their core values previously. For the participants in this study,
the clinicians had not previously discussed values and objectives with their clients' families. This
can be a supportive process for families, as they undertake the process of pinpointing their main
objectives for ABA treatment and communicating these goals to clinicians.
While the independent variable was in place for both participants, we saw robust results
across monthly utilization of family guidance hours, social validity scores, and the families'
treatment plans. We found that as long as the video-based appeal was referred to, the results of
this study showed promising results. However, if it was not referred to, there was a decrement in
the utilization of family guidance hours. This was shown by the unplanned reversal of Erik’s
BCBA failing to schedule family guidance sessions. A mitigating factor for such oversight can
include high levels of burnout experienced in the field of ABA. Dounavi et al. (2019) found that
“excessive work demands positively correlate with high burnout” (p. 1). Competing
responsibilities and the overall work volume assigned to practitioners may result in clinicians
failing to schedule family guidance sessions.
The field of ABA has grown exponentially over the years. However, there is still a long
way to go in developing a cohesive method to integrate families and clients in programming. The
field requires an immediate paradigm shift in its training processes, as many BCBAs feel inept at
conducting family guidance and integrating families to become effective interventionists. Early
on in their development, children spend most of their time with their caregivers. Thereby, it is
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especially beneficial to engage families in ABA practices. As mentioned in the article by
Hailstone (2014), family involvement can increase the rate of skill acquisition in children.
Research has previously shown that parental engagement is a consistent and essential component
of ABA services, providing effectiveness for early intervention programs (Ozonoff & Cathcart,
1998). As mentioned previously, parent-implemented interventions are included among the
twenty-eight evidence-based practices.
In the age of developing technology, it is important for clinicians to utilize tools that can
streamline the process of programming development. Technology has given this generation the
ability to become more flexible in clinical approaches. COVID-19 provided the opportunity to
use technology (i.e., Zoom) that was available for use, but had not been adapted to the field. In
consideration of these developments, it is important to integrate available technology to optimize
connections between clinicians and families. Whether due to scheduling conflicts or language
barriers, using available technology can provide a common ground for BCBAs and families. This
study focuses on integrating the “virtual patient” model, which can fill in the gap for mutual
understanding that has long been missing in clinician-family relationships.
The virtual patient model used in this study is a novel contribution to the field of ABA
that can prove its usefulness during the age of technology. It provides a permanent product that is
available as a resource for the clinical team when making programming changes, completing
update reports for funding sources, and to streamline processes in the event of clinical team
changes. It provides clinicians the opportunity to refer back to the family’s core values and focus
on providing support that is meaningful for the family.
It is important to note a particular limitation of this study. Although this study qualifies as
a multiple baseline design, generally, studies using this method are enhanced with more robust
USING ACT AND A VIRTUAL PATIENT MODEL FOR FAMILY SUPPORT
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results across multiple replications. Future studies should focus on multiple replications.
Additionally, in the case of Erik’s support staff, we saw that the BCBA was unable to entirely
schedule the family guidance sessions, resulting in a decrease in utilization. Therefore, we
recommend that BCBAs and clinical supervisors benefit from an ACT-based workshop, in order
to help increase a values-based approach to designing programming for families. Future studies
can implement a similar ACT-based workshop for clinicians.
In summary, this research aimed to improve the quality of treatment plans and ensure
their alignment with family values. This study sought to enhance the effectiveness of family
guidance hours and ensure that the procedures, goals, and outcomes were recognized and valued
by family members and clinicians. By implementing a multifaceted intervention, these objectives
were accomplished when the independent variable was present. The findings demonstrated a
stronger alignment of treatment plans with familial values, increased involvement of families,
and heightened recognition of the societal worth of these strategies. This exploration not only
achieves its intended objectives but also lays the groundwork for future investigations,
solidifying the undeniable influence of integrating medical practices with family values and
Acceptance and Commitment Therapy.

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15
References
Association of American Medical Colleges. (2007). Effective use of educational technology in
medical education: summary report of the 2006 AAMC colloquium on educational
technology.
Barnes-Holmes, Y., Hayes, S. C., Barnes-Holmes, D., & Roche, B. (2002). Relational frame
theory: A post-Skinnerian account of human language and cognition. Advances in Child
Development and Behavior, 28, 101–138.
Blackledge, J. T., & Drake, C. E. (2013). Acceptance and commitment therapy: Empirical and
theoretical considerations. In S. Dymond & B. Roche (Eds.), Advances in relational
frame theory and contextual behavioral science: Research and application (pp. 219-252).
Oakland, CA: New Harbinger.
Blackledge, J. T., & Hayes, S. C. (2006). Using acceptance and commitment training in the
support of parents of children diagnosed with Autism. Child and Family Behavior
Therapy, 28(1), 1–18.
Cameron, M. J., Moore, T., Bogran, C., & Leidt, A. (2020). Telehealth for Family Guidance:
Acceptance and Commitment Therapy, Parent-Focused Preference Assessment, and
Activity-Based Instruction for the Support of Children with Autism Spectrum Disorder
and Their Families. Behavior analysis in practice, 1–7. Advanced online publication.
https://doi.org/10.1007/s40617-020-00443-w
Coyne, L. W., McHugh, L., & Martinez, E. R. (2011). Acceptance and commitment therapy
(ACT): Advances and applications with children, adolescents, and families. Child and
Adolescent Psychiatric Clinics of North America, 20(2), 379–399.
Deladisma, A. M., Cohen, M., Stevens, A., Wagner, P., Lok, B., Bernard, T., Oxendine, C.,
Schumacher, L., Johnsen, K., Dickerson, R., Raij, A., Wells, R., Duerson, M., Harper, J.
G., Lind, D. S., & Association for Surgical Education (2007). Do medical students
respond empathetically to a virtual patient?. American Journal of Surgery, 193(6), 756–
760. https://doi.org/10.1016/j.amjsurg.2007.01.021
Dounavi, K., Fennell, B., & Early, E. (2019). Supervision for Certification in the Field of
Applied Behaviour Analysis: Characteristics and Relationship with Job Satisfaction,
Burnout, Work Demands, and Support. International journal of environmental research
and public health, 16(12), 2098. https://doi.org/10.3390/ijerph16122098
Edelbring, S., Dastmalchi, M., Hult, H. et al. Experiencing virtual patients in clinical learning: a
phenomenological study. Adv in Health Sci Educ 16, 331–345 (2011).
https://doi.org/10.1007/s10459-010-9265-0
Ferguson, J., Craig, E.A. & Dounavi, K. Telehealth as a Model for Providing Behaviour Analytic
Interventions to Individuals with Autism Spectrum Disorder: A Systematic Review. J
Autism Dev Disord 49, 582–616 (2019). https://doi.org/10.1007/s10803-018-3724-5
USING ACT AND A VIRTUAL PATIENT MODEL FOR FAMILY SUPPORT
16
Gould, E. R., Tarbox, J., & Coyne, L. (2018) Evaluating the effects of Acceptance and
Commitment Training on the overt behavior of parents of children with autism. Journal
of Contextual Behavioral Science, 7, 81-88.
Hailstone, P. (2014). “Parent involvement in ABA/IBI: How, why, & what for?” Autism
Asperger’s Network Magazine.
Harris, R.F. (2006). Embracing your demons: an overview of acceptance and commitment
therapy. Psychotherapy in Australia, 12, 70.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2003). Acceptance and Commitment Therapy:
An Experiential Approach to Behavior Change. New York, NY: Guilford Press.
Hendricks, D.R. (2009). Overview of parent-implemented intervention. Chapel Hill, NC: The
National Professional Development Center on ASD, Frank Porter Graham Child
Development Institute, University of North Carolina.
Lundgren, T., Louma, J., Dahl, J., Strohsal, K., & Melin, L. (2012). The Bull's-Eye Values
Survey: A Psychometric Evaluation. Cognitive and Behavioral Practice. 19.
10.1016/j.cbpra.2012.01.004.
Ozonoff, S., & Cathcart, K. (1998). Effectiveness of a home program intervention for young
children with autism. Journal of Autism and Developmental Disorders, (1), 25-32.
doi:10.1023/A:1026006818310
Pantziaras, I., Fors, U., & Ekblad, S. (2015). Training with virtual patients in transcultural
psychiatry: do the learners actually learn?. Journal of medical Internet research, 17(2),
e46. https://doi.org/10.2196/jmir.3497
Pastrana S, Frewing T, Grow L, Nosik M, Turner M, Carr J. Frequently assigned readings in
behavior analysis graduate training programs. Behavior Analysis in Practice. 2016;3:1–
7.
Quintero, G. A., Vergel, J., Arredondo, M., Ariza, M. C., Gómez, P., & Pinzon-Barrios, A. M.
(2016). Integrated Medical Curriculum: Advantages and Disadvantages. Journal of
medical education and curricular development, 3, JMECD.S18920.
https://doi.org/10.4137/JMECD.S18920
Steinbrenner JR, Hume K, Odom SL, Morin KL, Nowell SW, Tomaszewski B, Szendrey
S, McIntyre NS, Yücesoy-Özkan S, Savage MN. Evidence-based practices for
children, youth, and young adults with Autism.The University of North Carolina at
Chapel Hill, Frank Porter Graham Child Development Institute, National
Clearinghouse on Autism Evidence and Practice Review Team. 2020. A recent
systematic review that identified evidence-based practice for autistic children and
youth.
USING ACT AND A VIRTUAL PATIENT MODEL FOR FAMILY SUPPORT
17
Symon, J. B. (2005). Expanding interventions with children with autism: Parents as trainers.
Journal of Positive Behavior Interventions, 7, 159-173.
Taylor, B. A., LeBlanc, L. A., & Nosik, M. R. (2018, September 20). Compassionate care in
behavior analytic treatment: Can outcomes be enhanced by attending to relationships
with caregivers? Behavior Analysis in Practice.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6743522/
Yi, Z., Dixon, M.R. Developing and Enhancing Adherence to a Telehealth ABA Parent Training
Curriculum for Caregivers of Children with Autism. Behav Analysis Practice 14, 58–74
(2021). https://doi.org/10.1007/s40617-020-00464-5

USING ACT AND A VIRTUAL PATIENT MODEL FOR FAMILY SUPPORT
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APPENDICIES
Treatment Plan

Appendix A: Table 1 - Erik’s Family
Standards Baseline Post-Assessment
Strength-Based Skills 0 2
Behavior Excesses 1 1
Skills Targeted 1 2
Progression Monitoring 0 1
Overall Goals and Objectives 0 2
Interprofessional Collaboration 0 1
Communication 0 2
Total 2 11

Appendix B: Table 2 - Erik’s BCBA
Standards Baseline Post-Assessment
Strength-Based Skills 0 2
Behavior Excesses 2 2
Skills Targeted 1 2
Progression Monitoring 0 1
Overall Goals and Objectives 0 2
Interprofessional Collaboration 2 1
Communication 1 2
Total 6 12

USING ACT AND A VIRTUAL PATIENT MODEL FOR FAMILY SUPPORT
19
Appendix C: Table 3 - Adam’s Family
Standards Baseline Post-Assessment
Strength-Based Skills 1 2
Behavior Excesses 1 2
Skills Targeted 1 2
Progression Monitoring 1 2
Overall Goals and Objectives 1 2
Interprofessional Collaboration 1 1
Communication 1 2
Total 7 13

Appendix D: Table 4 - Adam’s Clinical Supervisor
Standards Baseline Post-Assessment
Strength-Based Skills 1 2
Behavior Excesses 1 2
Skills Targeted 0 2
Progression Monitoring 1 2
Overall Goals and Objectives 0 2
Interprofessional Collaboration 0 0
Communication 1 2
Total 4 12

USING ACT AND A VIRTUAL PATIENT MODEL FOR FAMILY SUPPORT
20
Social Validity

Appendix E: Table 6 - Erik’s Family
Questions Baseline Post-Assessment
I am satisfied with the amount of input I am able to provide for my child’s programming. 1 5
I feel like an important figure in my child’s behavior intervention plan. 5 5
I feel included when my child’s intervention plan is being created or modified. 4 5
I feel the family guidance that I’ve received (if any) is sufficient to provide me with the skills and
knowledge needed to support my child.
2 4
I feel confident with assisting in teaching my child. 4 4
I feel confident intervening during concerning behaviors with my child. 4 4
I feel my values and needs are supported during family guidance sessions. 4 5
The programs included in family guidance and my child’s intervention plan align with my values. 4 5
I feel the programming for my child aligns with my values and family objectives. 4 5
I would recommend this process to another family. 4 5
Total 36 47
Appendix F: Table 6 - Erik’s BCBA
Questions Baseline Post-Assessment
I am satisfied with the amount of input I am able to provide for my client’s programming 4 5
I feel like an important figure in my client’s behavior intervention plan. 4 5
I feel the family guidance that I’ve provided (if any) is sufficient to provide the family with the skills and
knowledge needed to support my client.
3 4
I feel confident with assisting in teaching the client’s family. 3 3
I feel the family’s values and needs are supported during family guidance sessions. 3 4
The programs included in family guidance and my client’s intervention plan align with family values. 4 5
I feel the programming for my client aligns with family values and family objectives. 4 5
I would recommend this process to another family. 3 4
Total 28 34

USING ACT AND A VIRTUAL PATIENT MODEL FOR FAMILY SUPPORT
21
Appendix G: Table 7 - Adam’s Family
Questions Baseline Post-Assessment
I am satisfied with the amount of input I am able to provide for my child’s programming. 4 5
I feel like an important figure in my child’s behavior intervention plan. 4 5
I feel included when my child’s intervention plan is being created or modified. 3 5
I feel the family guidance that I’ve received (if any) is sufficient to provide me with the skills and
knowledge needed to support my child.
3 5
I feel confident with assisting in teaching my child. 3 4
I feel confident intervening during concerning behaviors with my child. 2 4
I feel my values and needs are supported during family guidance sessions. 3 4
The programs included in family guidance and my child’s intervention plan align with my values. 2 5
I feel the programming for my child aligns with my values and family objectives. 3 5
I would recommend this process to another family. 4 5
Total 31 47
Appendix H: Table 8 - Adam’s Clinical Supervisor
Questions Baseline Post-Assessment
I am satisfied with the amount of input I am able to provide for my client’s programming 3 5
I feel like an important figure in my client’s behavior intervention plan. 2 4
I feel the family guidance that I’ve provided (if any) is sufficient to provide the family with the skills
and knowledge needed to support my client.
1 4
I feel confident with assisting in teaching the client’s family. 3 4
I feel the family’s values and needs are supported during family guidance sessions. 1 5
The programs included in family guidance and my client’s intervention plan align with family values. 1 5
I feel the programming for my client aligns with family values and family objectives. 1 5
I would recommend this process to another family. 2 5
Total 14 37

USING ACT AND A VIRTUAL PATIENT MODEL FOR FAMILY SUPPORT
22

Appendix I:
Appendix J:
USING ACT AND A VIRTUAL PATIENT MODEL FOR FAMILY SUPPORT
23
Appendix K: Clinician’s Quality Assessment Rubric
Concept Components Scoring
Maladaptive Behaviors Maladaptive behaviors targeted
by the BCBA
● 0
○ Family not consulted about
maladaptive behaviors and procedures
used in the behavior support plan.
● 1
○ Family was consulted about
maladaptive behaviors and procedures
used in the behavior support plan, but
family input was not utilized.
● 2
○ Family was consulted about
maladaptive behaviors and the
procedures used in the behavior
support plan. Most family input was
assessed and included in the behavior
support plan.
Skills Targeted Skills targeted by the BCBA ● 0
○ Family was not consulted about skills
that are taught.
● 1
USING ACT AND A VIRTUAL PATIENT MODEL FOR FAMILY SUPPORT
24
○ Family consulted about some skills
being taught, but family input was not
utilized.
● 2
○ Family was consulted about all skills
that are taught. Family input taken
into consideration and highlighted in
the skill acquisition plan.
Progression Monitoring

Frequent monitoring of
progression in all skills and
maladaptive behaviors
● 0
○ Program progression is not monitored
on a monthly basis and is not updated
even after programs are mastered.
● 1
○ Program progression is sometimes
monitored on a monthly basis, and
programs are sometimes updated as
they are mastered.
● 2
○ Program progression is monitored on
a monthly basis and programs are
updated as they are mastered.
USING ACT AND A VIRTUAL PATIENT MODEL FOR FAMILY SUPPORT
25
Overall Goals and
Objectives
Families are consulted on the
goals and objectives that are
established. Goals and
objectives are observable and
measurable, the goal
description clearly states what
the behavior looks like with
reference to values the family
has previously noted.

● 0
○ Family has not been consulted when
goals and objectives were established.
● 1
○ Family has been previously consulted
when goals and objectives were
established, but family input has not
been incorporated into the goals and
objectives.
● 2
○ Family has been previously consulted
when goals and objectives were
established, and family input has been
incorporated to the goals and
objectives.
Team Coordination

All interventionists are clear on
their responsibilities, which are
highlighted throughout the
plan.

● 0
○ No team member responsibilities are
identified in each section OR no team
members are identified.
● 1
○ Not all interventionists are identified
or not all responsibilities are
USING ACT AND A VIRTUAL PATIENT MODEL FOR FAMILY SUPPORT
26
highlighted in each section of the
plan.
● 2
○ All interventionists are identified
AND their responsibilities are
highlighted in each section of the
plan.
Communication Establishing effective
communication requires a team
approach among all
stakeholders. Stakeholders
include people who desire to
support positive outcomes for
the client, e.g., school staff,
family, agencies support
groups, the client(s)
themselves, and others. Active
exchanges among all
stakeholders require each
partner to provide information
to one another. Exchanges
● 0
○ No complete data exchange with all
components:
i. Who
ii. Conditions
iii. Manner
iv. Content
v. Frequency
● 1
○ Data exchange about the client
includes some components (who,
conditions, manner, content,
frequency).
● 2
USING ACT AND A VIRTUAL PATIENT MODEL FOR FAMILY SUPPORT
27
can occur through phone calls,
email, notes home, data log
copies, etc.
○ Data exchange with all components
(who, conditions, manner, content,
frequency) must be present.
Final scoring Scoring:
● 0-3: Substandard programming
● 4-6: Programming requiring
correction
● 7-10: Acceptable programming

Appendix L: Family’s Quality Assessment Rubric
Concept Components Scoring
Maladaptive Behaviors Maladaptive behaviors targeted
by the BCBA
● 0
○ Family not consulted about
maladaptive behaviors and procedures
used in the behavior support plan.
● 1
○ Family was consulted about
maladaptive behaviors and procedures
used in the behavior support plan, but
family input was not utilized.
● 2
USING ACT AND A VIRTUAL PATIENT MODEL FOR FAMILY SUPPORT
28
○ Family was consulted about
maladaptive behaviors and the
procedures used in the behavior
support plan. All family input was
assessed and included in the behavior
support plan.
Sills Targeted Skills targeted by the BCBA ● 0
○ Family was not consulted about skills
that are taught. Skills are not tailored
to the client’s repertoire and are based
on a chronologic assumption.
● Complex play
programming when the
client has not mastered
one-step and two-step
instruction following.
● 1
○ Family consulted about some skills
being taught, but family input not
utilized. Some skills tailored to the
client’s repertoire.
● 2
USING ACT AND A VIRTUAL PATIENT MODEL FOR FAMILY SUPPORT
29
○ Family was consulted about all skills
that are taught. Family input is taken
into consideration and highlighted in
the skill acquisition plan. All skills are
tailored to the client’s repertoire.
Progression Monitoring Frequent monitoring of
progression in all skills and
maladaptive behaviors
● 0
○ There is no data collection method for
families to monitor behavioral
excesses or deficits.
● 1
○ There is a data collection method for
families to monitor behavioral
excesses or deficits, but it is not
monitored by the BCBA.
● 2
○ There is a data collection method for
families to monitor behavioral
excesses or deficits, and it is
monitored by the BCBA.
Overall Goals and
Objectives
Families are consulted on the
goals and objectives that are
established. Goals and
● 0
○ Family has not been consulted when
goals and objectives were established.
USING ACT AND A VIRTUAL PATIENT MODEL FOR FAMILY SUPPORT
30
objectives are observable and
measurable, the goal
description clearly states what
the behavior looks like with
reference to values the family
has previously noted.

● 1
○ Family has been previously consulted
when goals and objectives were
established, but family input has not
been incorporated to the goals and
objectives.
● 2
○ Family has been previously consulted
when goals and objectives were
established, and family input has been
incorporated to the goals and
objectives.
Communication Establishing effective
communication requires a team
approach among all
stakeholders. Stakeholders
include people who desire to
support positive outcomes for
the client, e.g., school staff,
family, agencies support
groups, the client(s)
themselves, and others. Active
● 0
○ No complete data exchange with all
components:
i. Who
ii. Conditions
iii. Manner
iv. Content
v. Frequency
● 1
USING ACT AND A VIRTUAL PATIENT MODEL FOR FAMILY SUPPORT
31
exchanges among all
stakeholders require each
partner to provide information
to one another. Exchanges
can occur through phone calls,
email, notes home, data log
copies, etc.
○ Data exchange about the client
includes some components (who,
conditions, manner, content,
frequency).
● 2
○ Data exchange with all components
(who, conditions, manner, content,
frequency) must be present.
Final scoring Scoring:
● 0-3: Substandard programming
● 4-6: Programming requiring
correction
● 7-10: Acceptable programming

USING ACT AND A VIRTUAL PATIENT MODEL FOR FAMILY SUPPORT
32
Appendix M: Social Validity
Scoring
1. Strongly Disagree
2. Disagree
3. Neutral
4. Agree
5. Strongly Agree

Clinician Questionnaire
1. I am satisfied with the amount of input I am able to provide for my client’s programming.
2. I feel like an important figure in my client’s behavior intervention plan.
3. I feel the family guidance that I’ve provided (if any) is sufficient to provide the family
with the skills and knowledge needed to support my client.
4. I feel confident with assisting in teaching the client’s family.
5. I feel the family’s values and needs are supported during family guidance sessions.
6. The programs included in family guidance and my client’s intervention plan align with
family values.
7. I feel the programming for my client aligns with family values and family objectives.
8. I would recommend this process to another family.
Please comment on any other concerns that were not addressed previously about your client’s
treatment plan.
USING ACT AND A VIRTUAL PATIENT MODEL FOR FAMILY SUPPORT
33
Appendix N: Family Questionnaire
1. I am satisfied with the amount of input I am able to provide for my child’s programming.
2. I feel like an important figure in my child’s behavior intervention plan.
3. I feel included when my child’s intervention plan is being created or modified.
4. I feel the family guidance that I’ve received (if any) is sufficient to provide me with the
skills and knowledge needed to support my child.
5. I feel confident with assisting in teaching my child.
6. I feel confident intervening during concerning behaviors with my child.
7. I feel my values and needs are supported during family guidance sessions.
8. The programs included in family guidance and my child’s intervention plan align with
my values.
9. I feel the programming for my child aligns with my values and family objectives.
10. I would recommend this process for another family.
11. Please comment on any other concerns that were not addressed previously about your
child’s treatment plan.

USING ACT AND A VIRTUAL PATIENT MODEL FOR FAMILY SUPPORT
34
Appendix O: Virtual Patient Video Steps
A collaborative Google Drive was created, with a folder for each family.
Families were invited using the email addresses associated with their Google email accounts.
1. Create an outline of your values and what you would like to highlight. Pick three values
and goals and explain why they are important for your family.
a. Don’t forget to mention what you care about the most, such as behavior targets,
and please give examples.
b. Include a few words about the emotions you are experiencing, and possibly some
of the thoughts you have that may be distressing.
c. You can create cue cards to help focus your thoughts. It may be beneficial to
practice the presentation beforehand.
d. Please keep the video to a maximum length of 5 minutes.
2. Make sure your family is available during the time you plan to shoot the video. It is
important for everyone who is a part of your child’s life and upbringing to be present
during the video and to express their feelings.
3. Find a setting in your home that is free of distractions (loud sounds, moving objects) and
has adequate lighting. This will be where your family will create the video.
a. Make sure everyone who is going to be in the video is visible in the recording.
4. Get a camera. You can use your phone, a tablet, or a laptop to create the video. Navigate
to the camera and choose the video setting.
5. Click the record button, and begin your presentation.
6. Once you have finished recording, click the record button once again to end the video.
The video will be saved in either your “photos and videos” (if you are using a phone or
USING ACT AND A VIRTUAL PATIENT MODEL FOR FAMILY SUPPORT
35
tablet) or your photobooth or desktop (for laptops). Make sure you know where the video
gets saved. You will need this information in the next steps.
7. Navigate to GoogleDrive.com or the Google Drive app.
a. Make sure to download the app if you are using a phone or tablet.
b. Sign in, or make an account if you have not previously used Google.
8. Once you have signed it, click “Upload.” Find your video file and click on it.
9. The next step is to share the video. Sharing can be done by uploading the video to the
shared Google Drive between you and the researcher.
a. To share via Google Drive:
i. Right-click (if using a laptop) or click on the three dots (...) icon (if using
the app).
ii. Choose the option of “Move to.”
iii. Click on the option of “Shared drives,” and choose the shared drive
designated for your child.
iv. Next, click on the option of “Move here.”
v. You have now uploaded the video to the shared drive!

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Asset Metadata

Creator Yedigaryan, Meri Varuzhevna (author)

Core Title Using Acceptance and Commitment Training and a virtual patient model for supporting families with children with autism spectrum disorder

School College of Letters, Arts and Sciences

Degree Master of Science

Degree Program Psychology

Degree Conferral Date 2023-08

Publication Date 07/06/2023

Defense Date 06/26/2023

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag acceptance and commitment training,Applied Behavior Analysis,family guidance,OAI-PMH Harvest,parent training,video-based values clarification,virtual patient model

Format theses (aat)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Tarbox, Jonathan (committee chair), Cameron, Michael (committee member), Manis, Frank (committee member)

Creator Email tellmeri@gmail.com,yedigary@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC113262025

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