Teaching Practitioners to Use the Bristol Stool Form Scale

The Bristol Stool Form Scale (BSFS) is an empirically validated and reliable tool used to measure stool health. Stool health may be especially important to monitor among individuals with limited verbal repertoires, as they may not be able to self-report stool health. Further, individuals with autism spectrum disorder are known to have a higher incidence of gastrointestinal (GI) distress. Participants in the present study were staff responsible for the care of individuals with ASD. These staff were trained to use the BSFS to identify stool type. A series of phases were conducted in which participants were shown various pictures of stool. In phase 1, participants were provided with instructions to assign a number based on the chart scoring system (1-7) to each picture. In phase 2, participants were given access to the BSFS. In phase 3, a trainer-facilitated discussion of each stool type was conducted. In phase 4, a full review of each picture was conducted, and feedback was provided for individual errors. Participants were re-tested at the end of each phase. All participants achieved mastery for BSFS use by phase 4, and of the participants who received a follow-up evaluation, this skill was maintained for up to 6 months from the completion of the training. This training took a maximum of one hour to complete, could be conducted individually or in a group, and required very little additional training to deliver effectively.