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The Effects Of Crossfit And Pharmacology On Generalized Anxiety Disorder Symptoms And Self-Efficacy Levels, Priscilla Kay Fleming May 2025

The Effects Of Crossfit And Pharmacology On Generalized Anxiety Disorder Symptoms And Self-Efficacy Levels, Priscilla Kay Fleming

Walden Dissertations and Doctoral Studies

Nearly half of individuals diagnosed with generalized anxiety disorder (GAD) who are provided with an SSRI or SNRI medication do not experience a clinically meaningful reduction of symptoms or a full remission of symptoms. A gap in the literature existed for comparisons of treatment approaches and their outcomes for GAD symptoms and self-efficacy levels. Research questions for this study were: Is there a difference in GAD symptoms between the CrossFit participants and pharmacology participants at the point of three months treatment regimen?, and Is there a difference in self-efficacy levels between the CrossFit participants and pharmacology participants at the point …

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Avoiding Recidivism Of Recently Released Offenders In North Carolina, Josue Genaro Galvez May 2025

Avoiding Recidivism Of Recently Released Offenders In North Carolina, Josue Genaro Galvez

Walden Dissertations and Doctoral Studies

There is a problem with recidivism in the North Carolina prison system and the United States. This study fills the gap in the literature by focusing on what life experiences contribute to behaviors in recently released offenders not to reoffend in North Carolina. Edmund Husserl's (1913) Transcendental Phenomenology used several angles of perception and a thematic analysis of the participant’s lived experiences. This study employed a purposive sampling method by targeting 17 participants who may have represented characteristics of the intended population. Researchers do not know what kept these released offenders from avoiding prison. This phenomenological design focused on the …

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Microlearning As An Effective Training Method For Healthcare Employees To Improve Competencies And Organizational Success, Laqurandra Weeks May 2025

Microlearning As An Effective Training Method For Healthcare Employees To Improve Competencies And Organizational Success, Laqurandra Weeks

Walden Dissertations and Doctoral Studies

Challenges in keeping healthcare employees motivated raise concerns to organizational leaders because of healthcare’s changing and complex environments. Healthcare leaders are concerned because, without the proper training, an employee’s level of competence may negatively affect the quality of care they provide and patient safety. The specific research problem is the lack of lived experiences regarding the effectiveness of microlearning that have not readily had access to healthcare employees’ feedback and their preference for learning to apply skills and knowledge in the workplace. Grounded in microlearning theory, the purpose of this qualitative hermeneutic study was to explore the lived experiences of …

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How School Professionals Perceive They Can Engage Parents In Helping Children In Fifth Grade Cope Adaptively With Stress, Hector Alejandro Soto May 2025

How School Professionals Perceive They Can Engage Parents In Helping Children In Fifth Grade Cope Adaptively With Stress, Hector Alejandro Soto

Walden Dissertations and Doctoral Studies

National education statistics indicate issues of aggressive behaviors in middle schools, such as bullying and disrespecting teachers. This suggests that fifth-grade students could benefit from parental intervention to manage stress and reduce such behaviors. However, there is limited information on effectively engaging parents in this process. The study involved a purposive sample of 20 school professionals from four schools in a large southwestern U.S. school district who were invited to address this gap. Nine professionals completed the online survey of six qualitative, open-ended questions regarding engaging parents in helping fifth graders cope with stress. The questions focused on establishing meaningful …

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Lived Experiences Of Hispanic Parents Considering Early Intervention Services For Developmentally Delayed Children, Karina Proffer May 2025

Lived Experiences Of Hispanic Parents Considering Early Intervention Services For Developmentally Delayed Children, Karina Proffer

Walden Dissertations and Doctoral Studies

Studies have demonstrated that children benefit significantly from Early Intervention (EI) services due to brain plasticity and rapid early development. EI supports growth and establishes foundational skills in cognitive, social, emotional, motor, language, and daily living domains. Research indicates that children who participate in EI programs experience positive outcomes in their academic trajectories. However, limited studies examine the lived experiences of Hispanic parents with children diagnosed with autism or intellectual disabilities who did not utilize EI services. This study explores the factors influencing these parents' decisions and experiences that hinder their children’s participation in the program. The Theory of Planned …

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Staff Education To Improve Gestational Diabetes Knowledge In Family Practice Staff, Lawretta Udogadi Aghomon May 2025

Staff Education To Improve Gestational Diabetes Knowledge In Family Practice Staff, Lawretta Udogadi Aghomon

Walden Dissertations and Doctoral Studies

The project was a staff education program on gestational diabetes mellitus (GDM) that was carried out in an outpatient primary health facility to help improve staff knowledge of GDM. GDM is a pregnancy complication where women with no history of diabetes become hyperglycemic during their gestational period. According to the Centers for Disease Control and Prevention, the percentage of mothers giving birth who received a diagnosis of diabetes during pregnancy has increased in the last 10 years. Limited healthcare staff knowledge is a constraint in preventing the increase of GDM incidence. The practice-focused question was: Among healthcare staff at a …

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Professional Identity Development Of Black Women Counselor Education And Supervision Students In Predominantly White Institutions, Demetria Kathryn Burleson May 2025

Professional Identity Development Of Black Women Counselor Education And Supervision Students In Predominantly White Institutions, Demetria Kathryn Burleson

Walden Dissertations and Doctoral Studies

Black women in counselor education and supervision (CES) programs at predominantly White institutions (PWIs) accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP) face unique challenges that significantly influence their professional identity development (PID). Systemic barriers, such as microaggressions, racial stereotyping, and limited institutional support, remain pervasive and underexplored in literature. The purpose of this qualitative hermeneutic phenomenological study was to explore the lived experiences of PID among Black women enrolled in CES doctoral programs at CACREP-accredited PWIs. This qualitative study, guided by Heidegger’s hermeneutic phenomenology and informed by intersectionality and social cognitive career theory, aimed …

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Early Childhood Educators’ Experiences Facilitating Learning Of Noncognitive Skills, Amanda Taylor May 2025

Early Childhood Educators’ Experiences Facilitating Learning Of Noncognitive Skills, Amanda Taylor

Walden Dissertations and Doctoral Studies

The problem that was addressed through this study is that early childhood educators need help supporting young children in learning noncognitive skills, such as socialization, perseverance, and self-efficacy. The purpose of this basic qualitative study was to explore early childhood educators’ experiences facilitating the learning of noncognitive skills, specifically socialization, perseverance, and self-efficacy. The study was grounded in the conceptual frameworks Nagaoka et al.’s noncognitive framework and Stingher’s learning to learn in early childhood framework. Data were collected through semistructured interviews with eight local early childhood educators who teach 3- and 4-year-olds, who were contacted via email, word of mouth, …

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Examining The Transition Planning Process For Students With High-Functioning Autism Spectrum Disorder, Sara Elizabeth Mathis May 2025

Examining The Transition Planning Process For Students With High-Functioning Autism Spectrum Disorder, Sara Elizabeth Mathis

Walden Dissertations and Doctoral Studies

Students with high-functioning autism spectrum disorder (ASD) typically experience less postsecondary success when compared to their neurotypical peers. The specific problem addressed in this study is that many students with ASD in the rural communities of Southwest Missouri are not experiencing post-graduation success. Guided by Schlossberg’s transition theory and Kohler’s taxonomy for transition programming 2.0, the purpose of this basic qualitative study was to explore secondary special education teachers’ perceptions of the transition planning process for students with ASD related to successes, challenges, and needed support. Ten special education teachers, representing five different schools, who worked directly with the transition …

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Culturally Responsive Pedagogy In Mathematics Instructional Practices For Students With Disabilities, Pendo S. Nyanda May 2025

Culturally Responsive Pedagogy In Mathematics Instructional Practices For Students With Disabilities, Pendo S. Nyanda

Walden Dissertations and Doctoral Studies

Middle school mathematics special education teachers struggle to integrate culturally responsive pedagogy (CRP) into their instructional practices for students with disabilities (SWDs). The purpose of this basic qualitative study was to explore middle school mathematics special education teachers’ understanding of CRP and the support needed to integrate it into mathematics teaching practices. CRP was the conceptual framework for this study, explaining that teaching practices that integrate students’ cultural backgrounds promote their academic success. Two research questions guided the exploration of teachers' understanding of CRP and the support they believe is needed for integrating it. The study collected data through semistructured …

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The Experience Of Non-English Speaking Hispanic Patients During Kidney Transplant Evaluation, Ana Ivette Merced-Castro May 2025

The Experience Of Non-English Speaking Hispanic Patients During Kidney Transplant Evaluation, Ana Ivette Merced-Castro

Walden Dissertations and Doctoral Studies

There has been an increase in the incidence of Hispanics being diagnosed with end stage renal disease (ESRD), which has evolved from the rise in type 2 diabetes and hypertension. However, Hispanics and African American people are less likely to receive kidney transplants than non-Hispanic White individuals, and many Hispanics referred for transplants often do not complete the evaluation process due to its complexities. The purpose of this qualitative narrative descriptive study, guided by the socioeconomic model, was to explore the lived experiences of non-English-speaking Hispanic patients during the kidney transplant evaluation process. Six participants were recruited for the individual …

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Trust-Related Health Beliefs In Medical Systems Among Black Americans Since Covid-19, Monique Johnson Dixon May 2025

Trust-Related Health Beliefs In Medical Systems Among Black Americans Since Covid-19, Monique Johnson Dixon

Walden Dissertations and Doctoral Studies

COVID-19 highlighted the longstanding systemic and structural racism that produced poor health outcomes in Black communities. Black minorities in the United States were disproportionately affected by the COVID-19 pandemic, with less access to health resources, low vaccine rates, and mistrust of healthcare providers and organizations. This interpretative phenomenological analysis (IPA) explored trust-related health beliefs with medical systems among Black Americans since COVID-19. The study explored the trust-related health beliefs through the six constructs of the health belief model—perceived susceptibility, perceived severity, perceived barriers, perceived benefits, cues to action, and self-efficacy. Data was collected through semi-structured interviews of six participants who …

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Mass Shooting Perceptions, Public Mental Illness Stigma, And Social Media Use: A Regression Analysis, Kayla Cross May 2025

Mass Shooting Perceptions, Public Mental Illness Stigma, And Social Media Use: A Regression Analysis, Kayla Cross

Walden Dissertations and Doctoral Studies

Mental illness is frequently associated with mass shootings in news media, which can result in negative stigma among individuals diagnosed with mental illness. While mental illness and mass shootings have been explored previously, social media perceptions have not yet been examined in relation to mental illness stigma and mass shootings. The purpose of this study was to examine public mental illness stigma, mass shootings, and perceptions through social media in a correlational study subjected to regression analysis. The theoretical framework for the study was based on Tajfel and Turner et al.’s theory of social identity and intergroup behaviors. The analysis …

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Minority Stressors As Predictor Variables For Animal Abuse In Lgbtq Same-Sex Relationships With Interpersonal Violence, S Paige Brenner May 2025

Minority Stressors As Predictor Variables For Animal Abuse In Lgbtq Same-Sex Relationships With Interpersonal Violence, S Paige Brenner

Walden Dissertations and Doctoral Studies

LGBTQ individuals face a distinct set of societal issues that can lead to intimate partner violence (IPV) and animal abuse together. Grounded in minority stress theory, the purpose of the study was to reduce animal abuse in LGBTQ male and female same-sex relationships by examining the co-occurrence of internalized homophobia, degree of outness, and IPV. The hypotheses for the study include whether internalized homophobia and degree of outness predict animal abuse in LGBTQ same-sex relationships experiencing IPV. This study was conducted with a population of individuals (N = 149) with inclusion criteria of being 18 years of age or older, …

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Efficient Pharmaceutical Supply Chain Management Strategies For Tertiary Care Hospitals In The Caribbean, Lee Ann Salandy May 2025

Efficient Pharmaceutical Supply Chain Management Strategies For Tertiary Care Hospitals In The Caribbean, Lee Ann Salandy

Walden Dissertations and Doctoral Studies

This review aims to identify evidence-based quality improvement strategies and practical operational solutions to boost pharmaceutical supply chain performance in tertiary care hospitals in the Caribbean. This integrative review synthesizes empirical and non-empirical sources related to pharmaceutical supply chain systems and is grounded in Lean Six Sigma methodologies and supply and demand theory. The articles reviewed, published between 2014 and 2025, were appraised using the Johns Hopkins Evidence-Based Practice Model. Key themes identified included Lean Six Sigma principles, with subthemes such as lean distribution focus, value stream mapping, and the DMAIC process. The supply and demand theme included factors in …

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Teachers' Multiculturalism And Digital Learning Choices For Students With Limited Or Interrupted Formal Education, Jitka Nelsonova Brychtova May 2025

Teachers' Multiculturalism And Digital Learning Choices For Students With Limited Or Interrupted Formal Education, Jitka Nelsonova Brychtova

Walden Dissertations and Doctoral Studies

The English language learner environment in U.S. secondary schools is increasingly complex due to the growing numbers of students with limited or interrupted formal education (SLIFE) who require a culturally responsive approach. Teachers are not prepared to meet the needs of SLIFE, especially in the technology-enhanced classrooms. A gap in the literature exists regarding the culturally responsive use of digital learning resources (DLRs) with high school SLIFE. The purpose of this quantitative study was to examine whether the teachers’ self-reported multicultural teaching competencies (skills and knowledge) predict the choice of DLRs used with SLIFE. The study was grounded in Vygotsky’s …

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Self-Efficacy In Women Using Bioidentical Hormone Replacement: A Factor Analysis, Shanna Persin May 2025

Self-Efficacy In Women Using Bioidentical Hormone Replacement: A Factor Analysis, Shanna Persin

Walden Dissertations and Doctoral Studies

Bioidentical hormone replacement therapy has gained increasing attention as an alternative to traditional hormone replacement therapy (BHRT), yet research on self-efficacy related to BHRT adherence remains limited. Guided by Bandura’s social cognitive theory, this quantitative study examined the applicability of the hormone replacement self-efficacy (HRT-SE) scale in a population of BHRT users. Using factor analysis, this study assessed the reliability and validity of the HRT-SE scale in measuring self-efficacy among women using BHRT. The study recruited a convenience sample of 628 participants through online peri/menopause and hormone therapy support groups, collecting self-reported data on confidence in managing BHRT regimens. Findings …

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A Qualitative Analysis Of Teachers' Perceptions Of School Security Measures, Rozetta Michelle Isaac May 2025

A Qualitative Analysis Of Teachers' Perceptions Of School Security Measures, Rozetta Michelle Isaac

Walden Dissertations and Doctoral Studies

This study explored the lived experiences of six middle school teachers who provided their perceptions of school safety measures at their work locations. This phenomenological qualitative study aimed to examine whether the participants feel safe while at work. The theoretical framework that guided this study was PET (Punctuated Equilibrium Theory) which focuses on policy change over time. Participants were given a survey questionnaire to answer. The survey questionnaire contained open-ended survey questions. The survey was utilized in lieu of in-person interviews (due to COVID -19 restrictions). Participants were asked open-ended questions about their experiences and perceptions regarding school safety measures. …

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Effective Strategies Remote Business Leaders Use For Monitoring And Improving Remote Employees’ Performance, Lama Najem May 2025

Effective Strategies Remote Business Leaders Use For Monitoring And Improving Remote Employees’ Performance, Lama Najem

Walden Dissertations and Doctoral Studies

The shift to remote work has created leadership challenges in communication, career development, performance monitoring, trust, and time management. Remote business leaders are increasingly concerned about maintaining employee engagement and productivity, as ineffective leadership strategies can result in disengagement, reduced performance, and higher turnover in virtual work environments. Grounded in transformational leadership theory, the purpose of this qualitative pragmatic inquiry was to identify and explore effective strategies that remote business leaders used to support work-from-home employees and sustain organizational performance. The participants were eight remote team business leaders from the United States, Lebanon, and the United Arab Emirates. Data were …

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Evaluating The Factors That Lead To A Lack Of Gender Diversity Among Senior Level Executives In The Federal Bureau Of Investigation, Joyce A. Wallace May 2025

Evaluating The Factors That Lead To A Lack Of Gender Diversity Among Senior Level Executives In The Federal Bureau Of Investigation, Joyce A. Wallace

Walden Dissertations and Doctoral Studies

Despite progress in workplace equality, women face barriers to advancement in the FBI. This underrepresentation raises concerns about organizational performance and decision-making. The purpose of the study was to explore the obstacles to promoting women to senior leadership positions within the FBI by focusing on gender roles, social expectations, and organizational culture. The qualitative phenomenological approach used interviews with female law enforcement officers in conjunction with feminist theory. The study findings identified biases in selection processes, discriminatory hiring practices, non-inclusive workplace culture, and limited professional development opportunities as barriers to promotion. Cognitive and cultural biases that hindered progress were stereotypes …

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Enhancing Strategies For Government Partnerships To Meet Organizational Goals And Objectives, Nuela Uche Umeh May 2025

Enhancing Strategies For Government Partnerships To Meet Organizational Goals And Objectives, Nuela Uche Umeh

Walden Dissertations and Doctoral Studies

Organization X’s mission to strengthen legal rights and rehabilitate inmates involves effective collaboration with government entities. Organization X struggled to build strong partnerships with government agencies, limiting its ability to provide legal aid and rehabilitation services to marginalized inmates and victims of human rights violations. The purpose of this study was to use a SWOT analysis to explore the challenges and opportunities in government partnerships, aiming to identify barriers and recommend strategies to strengthen collaboration, build staff capacity, and enhance service delivery. Guided by four research questions, the study examined barriers and opportunities in government partnerships. Data were collected through …

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Examining The Relationship Between Leadership Styles, Staff Performance, And Staff Retention In Medication-Assisted Treatment, Chauncey Manique Tims May 2025

Examining The Relationship Between Leadership Styles, Staff Performance, And Staff Retention In Medication-Assisted Treatment, Chauncey Manique Tims

Walden Dissertations and Doctoral Studies

This case study examines the influence of leadership styles on employee retention and performance in medication-assisted treatment (MAT) facilities located in the southeastern United States, with a focus on facilities treating patients with severe opioid use disorder (F11.20). Using the Baldrige Excellence Framework, the study explores how different leadership approaches impact the work environment, employee satisfaction, and retention. Data were collected through semi structured interviews with six clinic directors, one regional clinical supervisor, and one regional director, as well as a review of organizational archival records and a literature review. The analysis revealed several key findings: (a) staff licensure requirements …

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Success Strategies Small Business Enterprise Leaders Use To Effectively Develop Resource Capabilities For Sustainable Growth, Denean Lear May 2025

Success Strategies Small Business Enterprise Leaders Use To Effectively Develop Resource Capabilities For Sustainable Growth, Denean Lear

Walden Dissertations and Doctoral Studies

Small business leaders often lack effective strategies to develop resource capabilities essential for sustainable growth. This gap challenges their ability to navigate complex and uncertain business environments, which can lead to missed opportunities and long-term instability—making it a critical concern for leaders and entrepreneurs striving for organizational resilience and success. Grounded in the dynamic capabilities’ framework, the purpose of this qualitative pragmatic inquiry was to explore strategies small business leaders used to develop resource capabilities for effective, sustainable growth. The participants were nine managers of social enterprise and nonprofit organizations from a cross-sector of industries in the Greater Philadelphia area, …

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Secondary Teachers’ Perspectives About Promoting Belongingness For Marginalized Students, Michelle Cottrell-Williams May 2025

Secondary Teachers’ Perspectives About Promoting Belongingness For Marginalized Students, Michelle Cottrell-Williams

Walden Dissertations and Doctoral Studies

Although school belonging supports well-being and academic achievement, marginalized students may experience less belongingness than their peers. Educators contribute to students’ sense of belongingness, but a gap in the literature existed about how secondary teachers perceive the promotion of belongingness for marginalized students. Guided by the ethic of care conceptual framework, the purpose of this basic qualitative study was to explore secondary teachers’ perspectives about promoting belongingness for marginalized students. The research question addressed secondary teachers’ perspectives about strategies, enablers, and barriers. The 11 participants were secondary teachers; members of the National Network of State Teachers of the Year or …

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From The Classroom To The Boardroom: Reducing Teacher Turnover By Enhancing Employee Engagement, Robert Thurston Fitzgerald Britton May 2025

From The Classroom To The Boardroom: Reducing Teacher Turnover By Enhancing Employee Engagement, Robert Thurston Fitzgerald Britton

Walden Dissertations and Doctoral Studies

Teacher turnover and low engagement levels present significant challenges for K-12 public schools, destabilizing academic progress and underscoring the need for educational leaders to develop sustainable strategies for teacher retention and positive work environments. The purpose of the qualitative pragmatic inquiry was to explore high-performing K-12 district educational leaders' strategies to enhance employee engagement and reduce turnover. The study involved six district or school-based leaders, all with over 10 years of educational experience and at least 2 years in leadership roles. The study was grounded in the self-determination theory and focused on autonomy, competence, and relatedness in influencing teacher engagement …

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African American Men’S Perception Of Fear Of A Deadly Encounter With Police During Traffic Stops In Detroit, Delshawn King May 2025

African American Men’S Perception Of Fear Of A Deadly Encounter With Police During Traffic Stops In Detroit, Delshawn King

Walden Dissertations and Doctoral Studies

This qualitative, phenomenological study is an examination of the fear of deadly encounters during traffic stops as experienced by seven African American men in Detroit. This fear is rooted in the historical context of slavery, where laws permitted the use of force to control African Americans. Using the critical race theory framework, the impact of traffic stops on African American men was explored, including how these encounters contribute to fear, psychological distress, and potential escalation of violence in interactions with law enforcement. The study shows that the fear of police encounters significantly impacts the psychological well-being, trust, and security of …

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Nurse Practitioner And Physician Assistant Staffing To Bridge Physician Shortages In North Carolina Rural Clinics, Robin Alisha Tyson May 2025

Nurse Practitioner And Physician Assistant Staffing To Bridge Physician Shortages In North Carolina Rural Clinics, Robin Alisha Tyson

Walden Dissertations and Doctoral Studies

Physician shortages in North Carolina rural counties are a problem that continues to affect patient care, which has necessitated the need to use other disciplines such as nurse practitioners (NPs) and physician assistants (PAs). The purpose and review question for this integrative review focused on determining best practices for utilizing PAs and NPs in rural clinics and how these staffing options could improve health outcomes. The administrative management theory served as the framework for this project by emphasizing the functions of planning, organizing, coordinating, and teamwork. A search of both empirical and nonempirical literature for years 2019 through 2024 was …

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Staff Education To Standardize Handoff Communication Protocols: Enhancing Patient Safety, Delali Adjele Tetteh-Assiakoley May 2025

Staff Education To Standardize Handoff Communication Protocols: Enhancing Patient Safety, Delali Adjele Tetteh-Assiakoley

Walden Dissertations and Doctoral Studies

Summary This doctor of nursing practice (DNP) staff education project focused on providing a staff education program on standardized handoff communication protocols to enhance patient safety and communication efficiency and effectiveness of information exchange at the practicum site. The practice problem is the lack of consistency regarding handoff communication, which results in miscommunication, inefficiencies, and possible preventable patient harm. Under conditions of poor handoff communication, medical errors, delays in treatment, and adverse patient outcomes are well documented. The project sought to improve the nursing staff’s knowledge of standardized handoff tools through a structured education program guided by the following practice-focused …

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Staff Education To Facilitate Patient Medication Adherence Among Schizophrenia Patients, Fri Florence Fon May 2025

Staff Education To Facilitate Patient Medication Adherence Among Schizophrenia Patients, Fri Florence Fon

Walden Dissertations and Doctoral Studies

Over the years, mental health practice has been characterized by a lack of compliance by schizophrenic patients after receiving a prescription for medication when discharged from the hospital (Kim et al., 2020). This issue has adversely affected the quality of experience and treatment outcomes among schizophrenia patients in my organization, an outpatient mental health clinic a similar challenge exists. Many patients diagnosed with schizophrenia struggle with medication adherence postdischarge, leading to increased relapse rates and hospital readmissions. This recurring issue has highlighted the need for enhanced patient education to improve compliance. The identified practice problem was the need for a …

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The Lived Experiences Of Registered Behavior Technicians Using Applied Behavior Analysis With Children With Autism Spectrum Disorder, Rebecca Rene Wyble May 2025

The Lived Experiences Of Registered Behavior Technicians Using Applied Behavior Analysis With Children With Autism Spectrum Disorder, Rebecca Rene Wyble

Walden Dissertations and Doctoral Studies

The prevalence of autism spectrum disorder (ASD) has increased dramatically over the past 20 years; the Centers for Disease Control describe ASD as an epidemic of need. Individuals with ASD need proper treatment and support services. One of the most significant needs is for applied behavior analysis (ABA), which is considered the most effective treatment for ASD, yet several barriers impede caregivers’ ability to access ABA, such as the shortage of ABA practitioners, including registered behavior technicians (RBTs). This qualitative phenomenological study explored the lived experiences of RBTs working with children with ASD in ABA settings in the United States. …

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