SELF-RECORDING IN TRAINING GIRLS TO INCREASE WORK AND EVOKE STAFF PRAISE IN AN INSTITUTION FOR OFFENDERS1

Self-recording procedures were used by four adolescent girls to increase work and comments (cues) that evoked staff praise during vocational training sessions in a maximum-security institution for offenders. The girls were selected on the basis of their not responding to a staff-directed token program. The self-recording procedures were directed by a therapist who saw the girls outside the vocational training sessions. According to a multiple-baseline design, self-recording of work was introduced sequentially to each of the two or three settings the girls attended each day. A few days after work had increased, self-recording of cues was introduced. Tokens were delivered by the therapist for work and cues recorded by the girls. Work and cues increased following self-recording for three of the girls and increased cues evoked higher rates of staff praise. Girl and staff behaviors were maintained during short follow-up periods when tokens were not given for the girls' records. The procedures failed to effect desirable changes with a fourth girl's work, and self-recording of work was terminated without introducing cueing.     

EVALUATING A SUPERVISION PROGRAM FOR DEVELOPING AND MAINTAINING THERAPEUTIC STAFF-RESIDENT INTERACTIONS DURING INSTITUTIONAL CARE ROUTINES

This study evaluated a program to teach and maintain language training interactions between institutional staff and profoundly handicapped children during a routine care task. Following baseline observations of bath sessions, staff were sequentially taught in multiple baseline fashion to vocalize more during the bath, praise child vocalizations, imitate sounds, and provide sound prompts. Procedures included a brief in-service meeting followed by a series of supervisory prompts and feedback. Results indicated that staff acquired the interaction skills in the bath sessions and that the skills generalized to another direct care task, dressing. The number of days on which components of supervision were implemented decreased from 47% of all days during the experimental conditions to 19% of the days during a 19-week maintenance period with no decrease in staff behavior. The interactions were shown not to interfere with the quality of the direct care task nor to increase the amount of time necessary to complete it. Also, some increases were noted for child vocalization frequencies. The advantages of providing therapeutic interactions during care routines are discussed along with the need for staff management techniques with long-term maintenance value.     

A PERFORMANCE-BASED LOTTERY TO IMPROVE RESIDENTIAL CARE AND TRAINING BY INSTITUTIONAL STAFF

Two experiments were conducted on four units of a residential facility for the multiply-handicapped retarded in an attempt to improve daily care and training services. Experiment I compared the effects of two procedures in maintaining the work performance of attendants, using an A-B design on two units. One procedure consisted of implementing specific staff-resident assignments, the other consisted of allowing attendants who had met performance criteria to be eligible for a weekly lottery in which they could win the opportunity to rearrange their days off for the following week. Results showed that the lottery was a more effective procedure as measured by the per cent of time attendants engaged in predefined target behaviors, and by their frequency of task completion in several areas of resident care. Experiment II replicated and extended these results to the area of work quality on two additional units, using a multiple-baseline design. The performance lottery was found to be an effective economical procedure that could be implemented by supervisory staff on a large scale.     

THE EFFECTS OF SEQUENTIAL PICTORIAL CUES,SELF-RECORDING,AND PRAISE ON THE JOB TASK SEQUENCING OF RETARDED ADULTS

The present study investigated the effects of a self-recording procedure using sequentially organized picture cues on independent task changes of four mentally retarded adults. Independent task changes were identified as the beginning of new tasks without directives or instruction. In addition to investigating treatment effects, the long-term maintenance of the task-change behavior was measured. During self-recording and picture-cue training, the subjects completed an increased proportion of independent task changes, and this behavior was maintained for more than 10 wk following removal of the training procedures. Self-recording using picture cues was shown to be an effective procedure for teaching mentally retarded adults to function more independently in a job setting.     

PEER TRAINING OF SAFETY-RELATED SKILLS TO INSTITUTIONAL STAFF: BENEFITS FOR TRAINERS AND TRAINEES

A peer training program, in which experienced staff trained new staff, was evaluated as a method for teaching and maintaining safety-related caregiver skills in an institutional setting for the developmentally disabled. Three sets of safety-type skills were assessed in simulated emergency situations: responding to facility fires, managing aggressive attacks by residents, and assisting residents during convulsive seizures. Using a multiple-baseline research design, results indicated that the peer training program was an effective method of training the three types of emergency skills to new direct care staff. The program also appeared effective in improving the skills of the peer trainers. Perhaps most importantly, results indicated that if experienced staff functioned as peer trainers for particular emergency skills, then their proficiency in those skills maintained over time whereas their proficiency declined in emergency skills for which they did not act as peer trainers. Social validity information collected from available staff 23 months after the program was completed supported the utility of the training in terms of staff responses during actual emergencies. Also, acceptability measures indicated that staff liked participating in the program. However, some inconsistencies between staff verbal reports and performance-based measures of acceptability were noted. Results are discussed regarding the overall effectiveness of the peer training program, the importance of maintenance strategies for safety-related skills, and the need for multidimensional analyses of staff acceptability in staff training/management research.     

AN INSTITUTIONAL STAFF TRAINING AND SELF-MANAGEMENT PROGRAM FOR DEVELOPING MULTIPLE SELF-CARE SKILLS IN SEVERELY/PROFOUNDLY RETARDED INDIVIDUALS

Although considerable attention has been given to the development of institutional staff training and management programs, the generalized effects of such programs on staff and resident behavior have seldom been examined. This study evaluated a program for teaching institutional staff behavioral training and self-management skills during self-care teaching sessions with severely and profoundly retarded residents. Following baseline observations in three self-care situations (toothbrushing, haircombing, handwashing), four direct care staff were sequentially taught to use verbal instruction, physical guidance, and contingent reinforcement in the toothbrushing program. During maintenance, staff were simultaneously taught to record, graph, and evaluate resident and their own behavior in the toothbrushing sessions. Staff were taught use of the training and self-management skills through a sequence of written instructions, videotaped and live modeling, rehearsal, and videotaped feedback. Observer presence and experimenter supervision were gradually decreased during the maintenance condition. Results indicated that during training and maintenance staff: (a) learned to use the training skills appropriately and consistently in the example situation (toothbrushing); (b) applied the skills in the generalization situations (haircombing and handwashing); and thereafter (c) maintained consistent and appropriate use of the skills with infrequent supervision. In addition, important changes in retarded residents' independent self-care responding occurred as staff training skills developed. Results are discussed in terms of their implication for future research and continued development of effective staff training and management programs.     

PYRAMIDAL TRAINING: A LARGE-SCALE APPLICATION WITH INSTITUTIONAL STAFF

This study evaluated an indirect method of training 45 institutional direct care staff to conduct behavioral programs. Three supervisors were trained to improve teaching behaviors (instructions, prompts, and consequences) used by the direct care staff while working with severely and profoundly handicapped residents. In addition to training, daily feedback was provided to supervisors regarding performance of their staff. Results of a multiple baseline analysis across teaching behaviors (instructions, prompts, and consequences) and content areas (communication and gross motor skills) showed that providing training and feedback to supervisors resulted in increases in correct teaching behavior by direct care staff. However, teaching behavior newly learned in one content area (communication) did not generalize to the other area (gross motor skills). Data collected on resident behavior showed small but noticeable improvement in terms of correct responses and attending behavior during programming. Results are discussed in terms of the benefits of a pyramidal approach to training institutional staff.     

A PARTICIPATIVE MANAGEMENT APPROACH FOR IMPROVING DIRECT-CARE STAFF PERFORMANCE IN AN INSTITUTIONAL SETTING

The present study evaluated a participative management approach for increasing the frequency of interactions between institutional staff and severely/profoundly retarded residents. The participative management approach involved teaching staff how to use self-monitoring, standard setting, self-evaluation, and self-reinforcement procedures. These procedures were then used by staff with minimal involvement of supervisory personnel. Although supervisors provided feedback and praise to staff for using these self-management behaviors, feedback and praise were never dispensed contingent on staff interactions with residents. Results indicated that during the participative management program there was an increase in staff interactions that were contingent on appropriate resident behavior. The increase in this type of staff interaction was accompanied by an increase in appropriate resident behavior. Follow-up data on both staff and resident behaviors, although showing moderating trends, suggested generally good maintenance of the initial behavior changes. Acceptability data suggested that staff were quite receptive to the program. The advantages of participative management procedures for improving staff performance in residential settings are discussed.     

REACTIVITY IN SELF-RECORDING: OBTRUSIVENESS OF RECORDING PROCEDURE AND PEER COMMENTS

Reactivity refers to behavior change that occurs during self-recording without specific programming of consequences. We analyzed the effects of obtrusiveness of recording procedure and peer comments on reactivity to self-recording. Three first-grade students in Experiment 1 completed math questions during a 5-min work period. When we gave the children recording devices and told them to try to complete more questions than the highest number they had previously completed, math performance increased, as did the number of verbalizations about it. Two children showed more reactivity when they used the more obtrusive recording device. Because the increase in math performance corresponded closely to increases in peer comments, we manipulated peer comments directly in Experiment 2. Four second-grade students completed a math task and an alphabet task. Three of the students showed increased math performance during periods when peer comments occurred compared to periods when peer comments did not occur. Although the data from the math task suggested that peer comments can enhance reactivity, we did not observe this relationship with the alphabet task. These results suggest that the conditions necessary to produce desirable results through self-recording are complex and contextually specific.     

INVOLVING INSTITUTIONAL STAFF IN THE DEVELOPMENT AND MAINTENANCE OF SIGN LANGUAGE SKILLS WITH PROFOUNDLY RETARDED PERSONS

A program to involve institutional staff in developing manual sign language skills with profoundly retarded persons was evaluated. In Experiment 1, six direct care staff, with close supervision, taught a small repertoire of signs to six profoundly retarded residents who had not benefited from previous training in vocal language. Training was conducted in a group format using instructions, modeling, manual guidance, contingent reinforcers, and feedback. During training, all residents learned to identify pictures of objects with manual signs. Generalization observations during unstructured times on the residents' living unit indicated that staff used their signing skills with the residents in addition to their vocal interactions but the residents did not increase their signing or vocalizing. In Experiment 2, the residents' skills in signing with real objects on their living unit as opposed to pictures of objects were evaluated and provided with additional training where necessary. Results indicated that all participating residents learned to communicate with signing during structured interactions on their living unit, and the skills maintained during follow-up assessments ranging from 39 to 49 weeks. Results are discussed regarding the variable generalization effects noted as well as the general benefits and disadvantages of teaching manual signing skills to profoundly retarded persons.     

A SUPERVISION PROGRAM FOR INCREASING FUNCTIONAL ACTIVITIES FOR SEVERELY HANDICAPPED STUDENTS IN A RESIDENTIAL SETTING

This study was designed to increase the amount of time severely handicapped students living in a residential facility engaged in age-appropriate and functional activities. After a brief in-service training, a program involving instructions to supervisors and staff feedback was implemented in a multiple-baseline design across settings. Results showed that after the supervision program was implemented, the students' participation in activities increased. Further, these increases maintained when feedback was reduced from an average of 3 days a week during treatment, to once a month for a 5-month period.     

EFFECTS OF SELF-MANAGEMENT TRAINING AND REINFORCEMENT ON THE TRANSFER OF IMPROVED CONDUCT IN THE ABSENCE OF SUPERVISION

The instruction, maintenance, and transfer of training of social skills of 3 seriously emotionally disturbed adolescents were accomplished by a self-management training and reinforcement package. During baseline sessions these students, who were covertly filmed in their classroom, averaged over 90% off-task or socially inappropriate behavior while their teacher was out of the room. They showed similar behaviors when walking between classes, unattended by their teacher. Treatment was introduced in the classroom and consisted of social skills and self-management training and reinforcement. Treatment procedures included instruction, modeling, and role playing of social skills, as well as self-assessment, self-recording, and self-reinforcement for correct approximations of these skills. After 5 weeks of training, all subjects demonstrated substantial improvements in the classroom during the teacher's absence and when distracted by other students; however, transfer of social skills did not occur to the between-class setting until students were given explicit instruction to initiate self-managing procedures in this setting.     

EFFECTS OF PROBLEM-BASED SCHEDULING ON PATIENT WAITING AND STAFF UTILIZATION OF TIME IN A PEDIATRIC CLINIC

The patient scheduling system in a pediatric outpatient clinic was changed from time-based to problem-based in an A-B-A-B reversal design. During baseline, time-based scheduling was in effect with patients being scheduled in 15-min periods regardless of presenting problem. During intervention, a receptionist matched client problems with time slots so that a more extensive treatment was allocated more time. Problem-based scheduling resulted in a substantial decrease in mean number of minutes spent in clinic across all presenting problems. Waiting time increased to baseline levels when problem-based scheduling was removed and decreased again on reintroduction of the program. A follow-up check conducted 1 month after the end of the second intervention phase revealed that the effects were maintained. The problem-based schedule also resulted in an increase in the proportion of extra time that medical staff had available and produced a positive consumer response.     

THE USE OF PROMPTS TO ENHANCE VICARIOUS EFFECTS OF NONVERBAL APPROVAL

The effect of nonverbal teacher approval (physical contact in the form of patting approvingly) delivered to target subjects on the attentive behavior of adjacent peers was examined in a special-education classroom. In a reversal design, two pairs of moderately retarded children were exposed to nonverbal approval, with only one subject in each pair receiving approval. In different phases, nonverbal approval was delivered alone or in conjunction with a verbal prompt directed to the adjacent peer or to the class as a whole. The prompt was designed to make salient the target subject's attentive behavior and the nonverbal reinforcing consequences that followed. Providing contingent nonverbal approval alone consistently altered attentive behavior of the target subjects but did not alter the attentive behavior of adjacent peers. However, accompanying nonverbal approval with a verbal prompt did increase attentive behavior of nonreinforced peers.     

REDUCING TIME LIMITS: A MEANS TO INCREASE BEHAVIOR OF RETARDATES1

A common assumption in special education is that temporal limits for a task should be expanded so that ample time is provided for completing the work. This study describes the opposite strategy of restricting temporal limits to augment academic performance. Three educable retarded children received token reinforcement contingent on the number of correct math problems answered during daily sessions. A reversal design was used to assess the effects of an abrupt reduction in time limits (20-5-20 min) and a graduated sequence of reductions (20-15-10-5-20 min). The graduated sequence resulted in rate increases of correct responding ranging from 125% to 266% and these gains endured when temporal limits were again expanded. In contrast, the abrupt shift produced interfering emotional behaviors and rate decreases in academic performance of 25% to 80%. The findings indicate that systematically restricting temporal limits for an academic task can further enhance the performance of slow learners already maintained by a token system.     

ONGOING CONSULTATION AS A METHOD OF IMPROVING PERFORMANCE OF STAFF MEMBERS IN A GROUP HOME

A model of ongoing consultation was implemented in a community group home for 8 adults with severe and profound mental retardation. Two consultants, highly experienced in working with people with mental retardation and in the procedures used in group homes, taught staff members to use a token reinforcement system, to engage the adults in a variety of activities, and to improve the content and style of the staff members' interactions with the adults. The consultants taught skills to 9 staff members through brief mini-workshops, direct observation of the staff members' use of the skills during regular activities in the group home, and individual verbal feedback regarding a staff member's performance of the skills. Evaluation of the ongoing consultation process by the 2 consultants showed it to be effective in improving the performance of the staff members and in changing the behaviors of the adults who lived in the home. Continued implementation of the process, however, appeared to be necessary for the behavior changes of staff members to be maintained at high levels.     

IMPROVING RESIDENTIAL TREATMENT SERVICES: IMPLEMENTATION AND NORM-REFERENCED EVALUATION OF A COMPREHENSIVE MANAGEMENT SYSTEM

Ensuring effective service delivery by direct-care personnel in institutional living units for persons with developmental disabilities historically has been a difficult process, despite considerable attention from researchers, service providers, and governmental regulatory agencies. In this investigation, we conducted a normative evaluation of the extent and quality of treatment services currently provided in residential living units (Experiment 1) and evaluated a comprehensive management system designed to improve such services (Experiment 2). Results of the first experiment, encompassing 22 living units in three states, indicated that on the average two thirds of observed resident behavior did not involve any therapeutic activity. The results also provided social validity for the criteria used to evaluate the quality of treatment provision based on opinions of mental retardation professionals. Results of the second experiment indicated that a behavioral management program implemented during 23 separate time periods across five living units was accompanied by consistent and durable decreases in resident nontherapeutic activity as well as increases in specifically designated habilitative activity. The results provide support for the successful incorporation of behavioral management technology into human service settings on a large-scale, long-term basis.     

ATTENTION TRAINING: THE USE OF OVERCORRECTION AVOIDANCE TO INCREASE THE EYE CONTACT OF AUTISTIC AND RETARDED CHILDREN

A crucial first step in teaching and training the retarded and autistic is to develop and maintain eye contact with the therapist. Functional movement training (an overcorrection procedure) plus edibles and praise were compared with edibles and praise alone as a method of developing eye contact in three such children. In both conditions, the child was given food and praise when eye contact occurred within 5 sec of the therapist's verbal prompt: “Look at me.” Functional movement training avoidance plus edibles and praise produced about 90% attention for the three children, while edibles and praise alone were less effective (eye contact never exceeded 55%). Functional movement training avoidance combined with edibles and praise appears to be an effective method of teaching eye contact and possibly other forms of instruction-following to behaviorally disordered children who are not always responsive to positive consequences.     

PYRAMIDAL STAFF TRAINING IN THE EXTENSION OF TREATMENT FOR SEVERE BEHAVIOR DISORDERS

We implemented a pyramidal training procedure for staff working with individuals who exhibited self-injurious behavior (SIB), aggression, and disruption. Two adults with developmental disabilities and their direct-care staff and supervisors participated. Following successful treatment by the experimenters, two types of baselines were conducted with the clients and their direct-care staff. During an initial baseline, the staff implemented preexisting procedures. Staff members then received instruction on the new treatment procedures using training methods common throughout the institution, and data were collected during this “post-in-service” baseline. Experimenters then taught unit supervisors to implement treatment, collect and interpret data, and provide similar instructions and feedback to the staff members. The supervisor training was implemented in a multiple baseline design across subjects (clients and direct-care staff). Results showed little change following in-service training but noticeable improvements in direct-care staff behaviors and corresponding decreases in the clients' inappropriate behavior following the pyramidal training intervention with supervisors. Six additional clients (along with their direct-care staff and supervisors) participated in pre- and posttreatment replication designs, and their results provided additional support for the efficacy of the supervisor training procedures.     

INCREASING HABILITATIVE SERVICES FOR PERSONS WITH PROFOUND HANDICAPS: AN APPLICATION OF STRUCTURAL ANALYSIS TO STAFF MANAGEMENT

We evaluated a structural analysis methodology for enhancing the utility of a staff management program. In Experiment 1, a structural analysis of direct-care staff behavior in a mental retardation facility revealed differences in work patterns over time. Specific times were identified when few basic care duties were necessary and staff engaged in nonwork activity. In Experiment 2, a management program was implemented to increase staff members' training activities during periods identified through the structural analysis. The program was accompanied by increases in training activities and decreases in nonwork behavior. The improvements were maintained during a 43-week period while the most labor-intensive component of the program was withdrawn. Staff acceptability measures indicated a positive response to the management intervention, although responses varied across components within the multifaceted program. The increased training was accompanied by beneficial changes among clients with profound handicaps. Results are discussed regarding practical considerations for improving staff performance and for adopting innovations resulting from applied research.