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Pilot: Scenario-Based Training and Teaching Safe Eating Practices

The impact of online scenario-based training on direct support professionals’ implementation of safe eating and drinking practices with individuals with intellectual and developmental disabilities


Accidental deaths resulting from choking is an increased concern to families, facilities and service providers of individuals with intellectual and developmental disabilities (Chadwick 2006). Research on effective training methods in safe eating and drinking protocols that teach Direct Support Professionals (DSPs) to identify dangers and implement safe eating and drinking practices is needed. Many organizations are starting to streamline their training programs by using online training. With the increased use of online staff training, there are questions about its effectiveness in increasing staff’s knowledge and generalizing knowledge on- the-job.

This study investigated whether training provided on the computer using Relias' scenario-based courses prepares DSPs to implement safe eating and drinking practices within scenarios, then generalizes the skills with clients and demonstrates retention of skills over time.

The course titled, "Bon Appétit: An Overview of Safe Eating and Drinking" is offered through Relias Learning's IDD library. The course teaches DSPs through interactive scenarios to:

  • Recognize when a person is choking
  • Identifying dangerous situations for individuals with modified diets
  • Identifying the onset of new problems and reporting them to appropriate people

safe eating and drinking coursesafe eating and drinking course



The study was conducted with 18 volunteers who are employees at Day Programs through Easter Seals Southern California. Sixteen of the Eighteen participants were females and all worked as Direct Support Professionals. Sixty-seven percent of participants had been working with individuals with IDD for 3+ years and eighty-two percent had already received training on safe eating and drinking practices and modified diets.



Staff were randomly assigned to an experimental group (n=10) and control group (n=8). Both groups received a pre-assessments that evaluated their baseline ability to identify dangerous situations in scenarios and general knowledge of dangerous foods and behaviors. They also rated their confidence in implementing their knowledge on-the-job.

After the pre-assessment, the experimental group immediately received the online training while the control group engaged in an unrelated training activity. Both the experimental and control group took a post-assessment to evaluate the change in knowledge and confidence. The control group then accessed the online training and completed the post-assessment again to evaluate a change in knowledge and confidence after the online training.

Sixty days and 120 days later, both groups completed assessments that evaluated their ability to generalize and retain the skills with their clients.

sample assessment question



Results in the graph below suggest that the experimental and control groups were not significantly different at the pre-test (73.1% vs. 77.8%, p = .17) yet both groups had a significant increase in knowledge at the first post-test assessment. For the experimental group, he intervention had a significant and positive impact on knowledge (73.1% vs. 83.6%, p = .004) and this level of knowledge was sustained and generalized at the 60-day (82.1%) and 120-day (80.2%) follow-ups (See Chart 1). The control group also showed an increase in knowledge between the pre-test and the first post-test (77.8% to 82.8%, p = .014).  This increase occurred without the intervention. Since the pre and post-assessment were identical, this increase could have been caused by the “practice effect” which is the ability to take the same test twice provides an opportunity to improve performance.

existing knowledge experiment results

The data in this study indicate that the training did have a significant impact on scenario-based knowledge of identifying dangerous situations in meals and this change was also retained over 120 days and generalized to the clients they serve. Since there was also a change in the control group, further study is needed to determine if the online training caused the change in knowledge in the experimental group.

There was no statistical change in confidence or in general knowledge of identifying dangerous foods or risky behaviors because pretest scores were already high for both these items demonstrating that participants already had some training and knowledge on the subject as reported. This data indicate that even DSPs with experience and training benefited from the intervention. Future research should be conducted with DSPs with little or no training and experience.

Some limitations to the study can offer opportunities for further study. Generalization tests were conducted after both groups had received some sort of training, as a result there was no control condition to compare generalization to in the absence of the training. Future studies should incorporate a control condition where generalization is assessed before any training is provided to determine what role the training had on skill generalization. The number of participants limits the ability to generalize the findings to all DSPs. Future research should include a larger sample size of DSPs with little to no experience working with individuals at risk for choking.  

Additionally, you can download the full whitepaper here.

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