An Evaluation of a Social Skills Application for Children Who Are Homeless

Abstract

Purpose:

Homeless children are more likely to have social skills deficits relative to same aged peers and may benefit from a social skills intervention. Therefore, the purpose of this study was to assess the Let’s Be Social application with the addition of behavioral skills training (BST) to teach social skills to children who were homeless.

Method:

This study used a multiple baseline across behaviors design to evaluate the effects of the iPad application and BST for teaching three social skills to three participants.

Results:

Participants did not demonstrate increases in targeted social skills after the introduction of the application, but social skills did increase after BST was added.

Conclusions:

The findings suggest that the application needs to be paired with BST in order to see improvement and maintenance in social skills. Future downloadable applications might consider including features that are similar to BST to assist in teaching social skills.

Keywords

applied behavior analysis behavioral skills training homeless children iPad social skills

According to the U.S. Department of Housing and Urban Development’s Annual Homeless Assessment Report to Congress in 2016, children who are under the age of 18 make up 22% of individuals who are homeless (Henry et al., 2016). There is a growing body of literature suggesting children who are homeless have a higher chance for physical, social, emotional, and cognitive development delays or related issues (Bassuk, DeCandia, Beach, & Berman, 2014; Buckner, 2008; DiBiase & Waddell, 1995; Koblinsky, Gordon, & Anderson, 2000). Research also suggests that children who are homeless are 3 times as likely to develop emotional and behavioral problems and have a higher probability of being diagnosed with learning disabilities compared to nonhomeless children (Bassuk et al., 2014; National Child Traumatic Stress Network Homelessness and Extreme Poverty Working Group [NCTSN], 2005). Additionally, these same youth are found to have social skills deficits (DiBiase & Waddell, 1995; NCTSN, 2005).

Elliott and Gresham (1993) suggest a deficit in social skills can be due to insufficient practice, lack of knowledge, absence of cues within the social environment, lack of reinforcement for performing the skills, or outside variables affecting the child’s performance of social skills. Although the exact cause of social skills deficits may not be known, there is research indicating children with these deficits typically face several maladjusted outcomes in regard to their social, academic, and physical development (Elliott & Gresham, 1993; Elliott, Malecki, & Demaray, 2001; Matson, Matson, & Rivet, 2007). Thus, the barriers experienced by youth who are homeless coupled with the long-term impact of social skill deficits suggest there is a need for evidence-based social skills programs.

Investigators have demonstrated that therapist-directed approaches are effective at teaching social skills to children (Bornstein, Bellack, & Hersen, 1977; Matson et al., 2007). For example, Bornstein et al. (1977) evaluated a social skills package including instructions, modeling, role-plays, and feedback to teach three elementary school children who were identified as being shy and unassertive. Results suggest the packaged approach was effective at teaching both social skills. In addition to therapist-directed approaches, technological approaches have been used to teach a wide range of behaviors including communication, academic, employment, transitioning skills, and social skills (Beaumont & Sofronoff, 2008; Escobedo et al., 2012; Kagohara et al., 2013). Although the overall outcomes were positive, there are inconsistencies in the level of improvement across the research (Beaumont & Sofronoff, 2008; Bernard-Opitz, Sriram, & Nakhoda-Sapuan, 2001; Otero, Schatz, Merrill, & Bellini, 2015; Ramdoss et al., 2012; Simpson, Langone, & Ayres, 2004). As advances in technology have occurred, different technological methods have been used to teach social skills (Beaumont & Sofronoff, 2008; Bernard-Opitz et al., 2001). A number of programs and easily downloadable applications have been developed and marketed for improving social skill deficits. However, limited research has been conducted to evaluate these applications. For instance, in a review of technology for teaching social skills to children with autism, no studies were found that evaluated the use of a downloadable application (DiGennaro Reed, Hyman, & Hirst, 2011). Given the popularity of these applications is rising, researchers should evaluate whether they produce positive results for children.

One highly rated application titled Let’s Be Social (Everyday Speech, 2015) can be found on iTunesÓ. Based on online reviews, it has been used by a variety of professionals (e.g., speech language pathologists, parents, social workers, and teachers). The application also received a 5 of 5 rating from individuals who had purchased it for US$19.99. The written anecdotal reviews were extremely positive from psychologists, speech pathologists, and parents indicating that the children who used the application improved in social skills. Unfortunately, at the time of this study, there were no formal studies evaluating the effectiveness of the application. Due to this limitation, the current study evaluated the effectiveness of the social skills application, Let’s Be Social (Everyday Speech, 2015) for children who were homeless, living in a temporary housing program, and reported by a teacher to have social skills deficits.

Method

Participants and Setting

We posted a flyer on the door of an after-school program at a not-for-profit housing assistance program in a metropolitan area. The housing assistance program provided a variety of services to families who were homeless including housing, food, and vocational assistance; counseling; and childcare. To participate in the study, the children were required to have prerequisite abilities associated with using a tablet application and engaging in the social skills that were assessed. Specifically, the inclusion criteria were the child had to be able to speak in four- to five-word sentences, respond to questions, and be able to manipulate a tablet (e.g., press buttons on the screen). In addition the study was conducted in a elementary after-school setting, therefore the children were between the ages of 5 and 12, were required to have parental consent to participate, and have a teacher or parent report that the child had social skills deficits. All children lived on-site in temporary housing and attended the on-site after-school program. Students who engaged in severe problem behavior that could result in injury to themselves or others were excluded from participating in the study. Children who were recommended by parents or teachers were observed by the researcher during after-school activities to ensure they met the inclusion criteria. All children recommended met inclusion criteria.

We held a meeting with parents who contacted us to provide additional information about the study and obtain informed consent. The study was reviewed and approved by a University Internal Review Board, and parents provided informed consent for their child to participate and children provided assent once at the beginning of the study. Child assent included information about the intervention but did not include details about the assessment procedures. We observed potential participants during free play to determine whether the participant met the inclusion criterion for verbal ability. Eight participants were originally recruited. Three participants were dropped from the study due to parental violation of organizational housing rules, which required them to move out of the site so their children were no longer attending the after-school program. Two participants dropped out of the study due to relocation. These participants either left prior to data collection or were in the baseline phase when they left the study. Therefore, the final sample was three participants. Zoey was a Hispanic, 7-year-old girl. She was an only child and lived with her mother. She attended a public school and was in second grade. Sandy was a Black, non-Hispanic, 6-year-old girl. She was the youngest of four children who lived with their mother and visited their father. She attended a public school and was in first grade. Kaylee was a Caucasian, 6-year-old girl. She was an only child and lived with her mother. She attended a public school and was in first grade.

We conducted the study in the housing assistance program’s after-school childcare center. The after-school program served a mean of 40 children per day. Children in the program attended public school and, based on parental report, were typically developing, although some children had diagnoses such as attention deficit hyperactivity disorder, oppositional defiant disorder, or social delay. We conducted sessions in a classroom located in the after-school program building. The children had previous exposure to the classrooms we used for the study. We conducted in situ assessments in the main room of the after-school program.

Materials

The materials included an Apple iPadÓ that the child used to operate the social skills application. We purchased the application Let’s Be Social (Everyday Speech, 2015) from the iTunes store for the application-based intervention phase. The application has five different categories (e.g., social relationships, handling change, and personal interactions). Within these categories are lessons specific to certain situations (e.g., greeting, waiting in line, and sharing). For each lesson, there is a short story and then a five question interactive quiz. Additional details regarding the application can be found at https://everydayspeech.com/apps/

Target Behaviors and Data Collection

Based on teachers’ concerns, we targeted greeting an adult, appropriately giving compliments, and sharing as the social skills for intervention. These target behaviors were ones that were taught within the social skills application and we attempted to keep the steps as close as possible to how the skills are taught within the application. The steps for greeting an adult were defined as (a) making eye contact, (b) making an introductory statement (e.g., “Hi My name is Sally”), (c) asking the adult his or her name (i.e., “What’s your name?”), (d) waiting __ s for the adult to answer, and (e) making a follow-up question or statement (e.g., “Where did you get that shirt?, Want to play with me?”). The steps for appropriately giving compliments were defined as (a) looking at object or area the adult described, (b) making eye contact with the adult, (c) making a pleasant statement (e.g., “I like that shirt!, Nice haircut, Cool toy!”), (d) waiting for the adult to respond, and (e) making a follow-up statement (e.g., “Where did you get that toy?, Thank you, I just got my hair cut yesterday!”). The steps for sharing were defined as (a) staying at the table, (b) playing the adult’s way for one turn (quietly allowing the adult to play his or her way while all items remained on table), (c) helping the adult play his or her way, and (d) playing during their turn. Observers recorded on a data sheet whether the participant completed each step of the target skill correctly (yes) or incorrectly (no). Performance was measured by calculating the number of steps completed correctly.

During the iPad application sessions, observers recorded the number of questions the participant answered correctly when she used the application and how long it took for the participant to complete the iPad application lesson and questions.

Interobserver Agreement

A second observer collected data simultaneously but independently during 55%, 61%, and 50% of sessions for Zoey, Sandy, and Kaylee, respectively. We defined an agreement as both observers recording that the participant completed the step correctly or both observers recording that the participant did not complete the step correctly. We defined a disagreement as one observer recording that the participant completed the step correctly and one observer recording that the participant completed the step incorrectly. We calculated agreement by dividing the number of agreements by the number of steps in the target skill and converting the ratio to a percentage. Mean agreement was 100%, 99%, and 99% for Zoey, Sandy, and Kaylee, respectively.

Procedures

Baseline

During baseline, the research assistants presented opportunities for participants to perform the targeted social skills. The participants were unaware that assessments were occurring. We trained the research assistants to collect data and respond to the participant during the assessment. New volunteers came into the after-school program on a daily basis; therefore, the presence of the research assistants was not unusual in the children’s environment. The assessments were conducted to assess the targeted social skills and always occurred in the main room of the after-school program. During the assessment for greeting an adult, the lead researcher and the research assistant stood within .9 m of the participant. The lead researcher said, “This is a new volunteer” and waited 10 s for the participant to respond. If the participant did not respond or made a negative comment, the lead researcher and the research assistant walked away. If the participant asked an unrelated question, the lead researcher answered the question briefly and walked away with the research assistant. If the participant responded according to the task analyzed steps, the research assistant responded by telling the participant his or her name (e.g., “My name is Sally.”).

During the assessment for appropriately giving compliments, the research assistant stood within .9 m of the participant and made a statement (e.g., “I got a new hair cut!, Look at this new toy, I got a new shirt.”). The research assistant waited 10 s and if the participant did not respond or made a negative statement, the research assistant walked away. If the participant asked an unrelated question, the research assistant answered the question briefly and walked away. If the participant responded according to the task analyzed steps, the research assistant engaged in a scripted response (e.g., “Thank you, I just got it!”).

During the assessment for sharing, the research assistant sat within .8 m of the participant and stated, “It’s time to play with Legos.” The research assistant played Legos with the participant for 5 min and followed all directions the participant gave on how to build with the Legos. After 5 min, the research assistant provided a statement about changing what they were building (e.g., “I want to build a house now, I want to build the house using only yellow blocks”). If the participant followed the research assistant’s description on what to build, the research assistant built that way for 2 min, then asked the participant how she would like to build. If the participant refused to play the research assistant’s way by saying “no,” making other statements of refusal, throwing objects, yelling, or leaving the table, the research assistant ended the assessment and told the participant it was time to play another activity. The research assistant played another activity with the participant for several minutes to ensure the participant was calm before sending her back to other activities in the after-school program. If the participant stayed at the table but did not play the research assistant’s way, the research assistant continued to play his or her way for 2 min. After 2 min, the research assistant asked the participant how she would like to build and proceeded to build that way.

Social skills application

After baseline, we gave each participant basic instructions to ensure participants could use the iPad. We conducted the social skills application training sessions in a room with no other children present. The researcher opened the social skills lesson on the iPad, passed the iPad to the participant, and stated, “Please complete the lesson.” The participant only had access to the social skills application during training. The application displayed a short story about using the target social skill. The participant could press a button, and the application would read the questions and answers aloud. After the story, the application asked the participant five multiple-choice questions. If the participant chose the correct response, a green check mark appeared on the screen with the message “That’s right!” If the participant chose an incorrect response, a red X appeared on the screen with the message “Incorrect.” After the participant completed the questions, the application presented the message “Good work!” and the number of stars that corresponded to the number of questions the participant answered correctly. The participant had to listen to or read the story and answer the questions again if she answered questions incorrectly. This process continued until she answered all questions correctly. After the participant answered all of the questions correctly, she was allowed to play a game of her choice on the iPad for 5 min. Then, the researcher took the iPad and escorted the participant back to the after-school program. Each participant completed the application individually.

Postapplication assessments

We conducted an assessment within 24 hr after the participant completed the training session for each targeted social skill. We conducted additional assessments as needed over the course of several weeks. All assessments were conducted in the same manner as baseline in the main room of the after-school program. We conducted another social skills training session, which we referred to as a booster session, if the participant did not score 100% on the assessment. The booster session was conducted in the same manner as the initial training. Booster sessions occurred shortly after failed assessments, typically at the end of the activity they were engaged in is when the assessment occurred. During the booster session, we presented the participant with the iPad application open to the targeted social skill, asked the participant to complete the lesson, and allowed 5 min on the iPad to play a game of her choice after she answered all questions correctly.

Application plus behavioral skills training (BST)

We conducted the application plus BST sessions in a private room in the after-school program with no other children present. The sessions started with the researcher providing instructions on the target social skill and reviewing the lesson on the iPad application. Then, the participants answered the five questions from the application. The participant had to read the story and answer the questions until she answered all questions correctly. After completing the application, the researcher provided instructions and modeled the correct steps for the target social skill. During modeling, the researcher asked the participant to play the role of the adult, allowing the researcher to model the correct steps for the target social skill.

After the researcher modeled the steps for the target social skill, the researcher presented the participant with a scenario and asked the participant to act out how she would respond (role-play). The participant acted as the participant and the researcher acted as the adult. The researcher immediately praised the participant after the role-play if she engaged in any of the steps for the target social skill. The researcher provided corrective feedback immediately after the role-play for missing or incorrect steps. If the participant failed to engage in any of the steps of the target social skill within 3 s, the participant received corrective feedback. Rehearsal and feedback continued until the participant had engaged in the target social skill 5 times with 100% accuracy. Once the participant completed the skill with 100% accuracy, the participant received specific verbal praise after completing the steps of the skill correctly. After the participant completed the training, we gave her 5 min on the iPad to play a game of her choice.

Post-BST assessments

After the participant completed the BST, we conducted an assessment within 24 hr. We conducted additional assessments as needed or until the participant completed all steps correctly for three consecutive assessments. We conducted the assessments in the same manner as baseline. We conducted another social skills training session (i.e., a booster session) if the participant did not complete the steps with 100% accuracy and we conducted the booster session in the same manner as the initial BST. During the booster session, the participant reviewed the target social skill on the iPad application. Then, the researcher provided instruction on the skill and modeled the skill. Next, the participant role-played the target skill, and the researcher provided praise and feedback. After the participant completed this step, we gave her 5 min on the iPad to play a game of her choice.

Follow-up

We conducted follow-up assessments approximately 2 weeks after each participant completed the post-BST assessment to determine if the social skills had maintained. We conducted follow-up assessments in the same manner as baseline.

Treatment Integrity

A second observer collected treatment integrity data on the researcher during the use of the iPad application and the BST sessions. A checklist was used that included all steps that the researcher needed to complete for each session (e.g., researcher opened the social skills application and the lesson, researcher instructed the participant to “complete the lesson”). Treatment integrity checklists were developed for both the application and the steps to implementing BST. An agreement was defined as both observers recording the same mark for each trial (i.e., both marking yes on the task analyses for the occurrence of the researcher implementing a step). A disagreement was defined as one observer marking yes and the other observer marking no. We calculated treatment integrity by dividing the number of agreements by the number of steps and converting the ratio to a percentage. We assessed treatment integrity on 42% of iPad sessions and 100% of BST sessions for Zoey. We assessed treatment integrity on 71% of iPad sessions and 100% of BST sessions for Sandy. We assessed treatment integrity on 59% of iPad sessions and 50% of BST sessions for Kaylee. Mean treatment integrity was 100% across all sessions for all three participants.

Social Validity

In order to determine the acceptability and satisfaction with the intervention procedures, we conducted surveys with both the participants and teachers after the intervention phase was completed. A teacher in the after-school program, who was not associated with the study, administered a questionnaire we developed for this study. The teacher read the questions to the participant if the participant could not read or gave the participant a written copy of the questions if the participant could read. The teacher instructed the participant to rate each question using a 5-point Likert-type scale. We also administered a questionnaire to the participants’ teachers at the after-school program and asked the teachers to respond to five questions using a 5-point Likert-type scale. Questions addressed their opinion of the interventions and if they noticed changes in the participants’ social skills.

Experimental Design

We used a concurrent multiple baseline across behaviors design to evaluate the effects of the iPad application and BST.

Results

All participants responded correctly to the social skills iPad application questions within three trials. Zoey required two trials for greeting, three for appropriate compliments, and two for sharing. Sandy responded correctly on the first trial for greeting and sharing, while taking two trials for appropriate compliments. Kaylee responded correctly to questions for all of the skills on the first trial. All of the participants had some variability in responding over time, but no decreasing trends in responding correctly were noted as participants were repeatedly exposed to the application scenarios.

Zoey’s data are shown in Figure 1 for greeting (top), appropriate compliments (middle), and sharing (bottom). Zoey completed one or two of the five steps for greeting and appropriate compliments during baseline and the iPad intervention. Zoey engaged in higher but variable levels of sharing during baseline and the iPad intervention, completing between two and four of the steps. After BST, Zoey immediately met mastery criteria for all behaviors and only required one booster training session to maintain mastery for appropriate compliments.

Figure 1.

Number of steps completely correctly within the task analysis for greeting (top), appropriate compliments (middle), and sharing (bottom) for Zoey.

Sandy’s data are displayed in Figure 2 for greeting (top), appropriate compliments (middle), and sharing (bottom). Sandy only engaged in one step during baseline and the iPad intervention for greeting. Sandy’s responding was higher but variable during the baseline for appropriate compliments, however, correct responding decreased during the iPad phase in which she only completed two out of the five steps. After we initiated BST, greeting and appropriate compliments increased, and she required only one booster session for greeting. Sandy’s responding during baseline for sharing was variable but high; therefore, we did not implement an intervention for sharing.

Figure 2.

Number of steps completely correctly within the task analysis for greeting (top), appropriate compliments (middle), and sharing (bottom) for Sandy.

Kaylee’s data are shown in Figure 3 for greeting (top), appropriate compliments (middle), and sharing (bottom). Kaylee only engaged in one step during baseline and the IPad phase for greeting. Kaylee completed all steps in the second session in the BST phase. Kaylee’s responding was variable across the baseline phases for appropriate compliments and sharing, with no improvement in the iPad phase. She completed all steps correctly and did not require booster training after BST.

Figure 3.

Number of steps completely correctly within the task analysis for greeting (top), appropriate compliments (middle), and sharing (bottom) for Kaylee.

Social Validity

For student social validity, one of the teachers at the after-school program read the social validity questions to the participants. The results showed that all three participants rated a 5 (strongly agree) for “the training helped me to get along with others better” and “I think other kids would like this training.” Zoey and Sandy rated “the training helped me to talk to new people” a 5, and Kaylee rated that statement a 3 (neutral). Two teachers completed the social validity assessment. Zoey’s teacher (Teacher 1) taught second- and third-grade students in the after-school program. Sandy and Kaylee had the same teacher (Teacher 2) who taught kindergarten and first-grade students in the after-school program. The results indicated that both teachers rated a 5 (strongly agree) that the “social skills chosen for this study were important.” The results were mixed for the teachers’ opinion as to whether “the intervention improved their student’s social skills” with rating of a 4 (agree) for Teacher 1 and a 3 (neutral) for Teacher 2. Both teachers rated a 4 (agree) that they “would recommend the intervention to other students who need help with social skills.”

Discussion and Applications to Practice

The purpose of this study was to extend the research on using technology to teach social skills to child who were homeless through the use of the Let’s Be Social application (Everyday Speech, 2015). All three students did not show improvements in the three social skills with only the iPad application and instead required the addition of BST to learn the steps for each targeted social skill. All participants reached mastery of the steps through the use of BST for all three of the skills, except Sandy who maintained high levels in baseline for sharing. Booster training was needed for one behavior for each participant to reach mastery criteria.

In regard to the social skills application phase, variable results were obtained across participants. For some of the social skills, the data collected during this phase were lower than baseline levels. Based on online reviews of the Let’s Be Social (Everyday Speech, 2015) application, it has been used by a variety of professionals (e.g., speech language pathologists, parents, social workers, and teachers) who left anecdotal reports suggesting the application was effective for teaching social skills. These positive reviews were one reason we chose to evaluate this particular application. However, we did not observe improvements in social skills with our participants until BST was added in which the participants practiced the skills. It should be noted that the booster sessions always occurred shortly after a failed assessment; therefore, it could be possible that access to the iPad may have served as a reinforcer for inaccurate responding during assessments. However, inaccurate responding did not continue to occur in the BST condition, when access to the iPad would have continued to occur after inaccurate responding, suggesting this was most likely not the case.

The results of this study align with those found in the literature on BST. In general, researchers have found knowledge-based training must be paired with BST when attempting to program for generalization of skills (Himle & Miltenberger, 2004; Himle, Miltenberger, Flessner, & Gatheridge, 2004; Houvouras & Harvey, 2014; Johnson et al., 2005; Stewart, Carr, & LeBlanc, 2007). These previous findings are consistent with our results. Also notable, this is the first study to evaluate the utility of using BST to teach social skills to youth who are homeless. Interestingly, applications are generally designed to be completed independently, however, if repeated exposures are required or are ultimately not effective, it may be that a few brief exposures to effective BST might be a more efficient intervention (for both therapists and participants). For all participants, only one exposure or two (for Kaylee’s greeting behavior) to BST led to an immediate increase to 100% of steps correct in the next assessment. This occurred after participants had between 3 and 6 exposures of the iPad application phase and subsequent booster sessions with no improvements during assessments.

Participants highly rated the social validity of the intervention for all questions except for Kaylee who rated a three for “did this help her talk to new people.” Anecdotally, Teacher 1 said while she was reading the social validity questions to Zoey, Zoey talked to her about the study and stated that she enjoyed participating. Teacher 1 also reported another staff member indicated they had seen a change in Zoey over the last few weeks. A volunteer noticed Zoey seemed more social and used more full sentences to express ideas to others.

A challenge during this study was participant attrition. As stated earlier, we originally recruited eight participants, however, due to circumstances unrelated to the study, only three participants completed the study. Attrition may be a greater challenge when working with families that are homeless or do not have stable housing. Another challenge to this study was that all three participants were inadvertently exposed to a Social Emotional intervention group run by a licensed mental health counselor. The intervention included instruction related to the skills for sharing. This group occurred while all three participants were still in baseline. The Social Emotional group was in session for 4 weeks and was conducted in a group format for each class. It is not clear if this may, in part, be responsible for the variability in the data for sharing.

A recommendation for future research studies would be to use the child’s peers in the assessments. We used adults which may not be equivalent to mastery of the same skills with peers in the child’s natural environment. Performance of the same skills with peers may require additional programming for generalization.

In summary, this study is one of a few that have evaluated iPad applications and BST to teach social skills to children. The study also expanded on the notion that youth who are homeless struggle with deficits in social skills (DiBiase & Waddell, 1995; National Child Traumatic Stress Network Homelessness and Extreme Poverty Working Group, 2005). Results suggest the knowledge-based application must be paired with BST when programming for mastery criteria and generalization. Furthermore, we found the skills maintained during follow-up probes. Although the follow-up probes showed that the skills maintained, we only conducted one follow-up probe for each participant 2 weeks after the BST phase. Future studies should collect more follow-up data to evaluate the maintenance of the targeted social skills.

Further research could evaluate other types of applications that target social skills and other behaviors. Although the iPad application assessed in this study was not successful at increasing social skills to mastery levels, future applications could incorporate features of BST. This might be helpful for the dissemination of research-based strategies within ABA to the general population and assist families that do not always have funding or need the least amount of sufficiency for help. Another feature that might improve results could be to incorporate video modeling or virtual reality into applications. This would potentially incorporate the modeling and role-play aspects of BST. Future research could also conduct additional follow-up probes and in situ assessments across a wider range of settings and people (i.e., peers) that children encounter.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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