TRAINING RESIDENTIAL SUPERVISORS TO PROVIDE FEEDBACK FOR MAINTAINING STAFF TEACHING SKILLS WITH PEOPLE WHO HAVE SEVERE DISABILITIES

We evaluated procedures for training supervisors in a residential setting to provide feedback for maintaining direct-service staff members' teaching skills with people who have severe disabilities. Using classroom-based instruction and on-the-job observation and feedback, 10 supervisors were initially trained to implement teaching programs themselves. The training improved supervisors' teaching skills but was insufficient to improve the quality of feedback they provided to direct-service staff regarding the staff members' teaching skills. Subsequently, classroom-based instruction and on-the-job observation and feedback that targeted supervisors' feedback skills were provided. Following training in provision of feedback, all supervisors met criterion for providing feedback to their staff. Results also indicated that maintenance of teaching skills was greater for direct-service staff whose supervisors had received training in providing feedback relative to staff whose supervisors had not received such training. The need for analysis of other variables that affect maintenance of staff performance, as well as variables that affect other important areas of supervisor performance, is discussed.     

Analysis of public verbal feedback as a staff management procedure

We evaluated public verbal feedback as a potentially effective and efficient means of improving institutional staff performance. Following baseline observations of the self-help training conducted by three groups of direct care staff with clients who had profound mental retardation, verbal feedback was presented publicly to individual staff during routine staff meetings. The feedback addressed the (in)frequency of the staffs training endeavors and required only a few minutes to present. Results indicated that each group of staff increased their client training when the public verbal feedback was provided. Probes of client self-help skills indicated that as the frequency of staff-conducted training increased, client skill acquisition improved. Generalization measures indicated that staff increased only those work behaviors for which they received feedback. Results are discussed regarding the efficiency of public verbal feedback as a means of improving staff performance, as well as the need for research to continue expanding and refining a technology of staff management.     

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.     

Increasing Communication Among Nursing Home Residents

In this preliminary, intrasubject study (N = 8), we examined the effects of communication skills training and the use of memory books by Nursing Assistants (NAs) on the social ecology of a nursing home. Through inservice and on-the-job training, NAs were taught to use communication skills and memory books during their interactions with residents with mild to moderate cognitive impairment (Mini Mental Status Examination, M = 16.25), but relatively intact communication abilities. An abbreviated staff motivational system called Behavioral Supervision (Burgio and Burgio, 1990. Int. J. Aging Hum. Deve. 30: 287–302.) was attempted to encourage performance of these skills on the nursing units. Results showed that, regardless of sporadic implementation of the intervention by nursing staff, the intervention improved communication between staff and residents during care routines, increased the amount of time other residents and visitors spent talking with target residents, and increased the rate of positive statements made by the target residents and others in their immediate environment. Results are discussed in terms of limitations of the staff motivational system and modifications made to the system in a larger ongoing intervention trial.     

Effects of outcome performance feedback on maintenance of client and staff behavior in a residential setting

This study examined effects of outcome performance feedback on maintenance of client and direct care staff behavior in a group home for four clients with severe/profound intellectual disability. Following baseline observations, 8 staff were instructed to prompt and praise interclient interactions and game activity during leisure sessions. Staff training comprised written instructions, in situ modeling and rehearsal, and performance feedback. This was followed by a 17-week maintenance period, during which staff received outcome performance feedback based on independent and self-recorded observations. Results showed that client gains were maintained, but did not stabilize. It was concluded that process feedback should have accompanied outcome feedback until staff behavior levels suitable for durable maintenance were obtained. In addition, successful use of performance feedback as a maintenance tool is highly dependent on which outcome behaviors are selected, and whether these are eventually naturally reinforced.     

Maintaining proficient supervisor performance with direct support personnel: an analysis of two management approaches

A traditional management approach using indirect feedback was compared to an approach involving direct feedback for maintaining supervisory proficiency in observing and providing feedback to staff. Three supervisors participated in each condition. The first 3 supervisors then received direct feedback. Direct feedback was accompanied by high levels of performance relative to the indirect feedback protocol. The need for maintenance procedures with supervisors is discussed.     

Evaluating the quality of training delivered by direct-care staff in a state mental retardation center

This study evaluated a center-wide training system in a state-operated mental retardation center. Staff performance was assessed under varying conditions with collateral measures collected on resident behavior. The quality of training delivered by direct-care staff was measured following the completion of an inservice training program and when individual feedback and praise were available or a group contingency where feedback, praise, and money were available. Inservice training was not found to be sufficient to maintain staff training skills. Providing feedback and praise had mixed results in maintaining staff behavior. A group contingency using feedback, praise, and money was found to be immediately effective in improving and maintaining staff behavior. Collateral measures on student behavior were also provided that indicated that consistent, quality training by staff resulted in increased student skill acquisition. These results are discussed within the framework of conducting research in applied settings.     

Evaluating the effects of reactivity to supervisor presence on staff response to tactile prompts and self‐monitoring in a group home setting

Because staff management research in group home settings typically involves direct observation of staff performance, reactivity to being observed is a potential limitation in these studies. The current study evaluated the use of a tactile prompt, self‐monitoring, and feedback to increase positive interaction in a group home setting. Reactivity was assessed by having a confederate observe staff positive interaction when the supervisor was present and when the supervisor was absent. The effect of supervisor presence was evaluated using an alternating treatment within a multiple baseline across participants' research design. Results showed that two of four participants increased positive interactions only when a supervisor was present and the two other participants increased positive interaction only when a supervisor was present and provided feedback. Copyright © 2010 John Wiley & Sons, Ltd.     

Performance feedback and maintenance of staff behavior residential settings

The literature on staff management reveals a problem in maintaining performance after training programs. The research suggests that maintenance will be maximized by providing regular feedback to relevant personnel, and that feedback, even when self-management procedures are incorporated, should be based on independent observations of client behavior. Outcome measures should indicate changes in client behavior that are valued by staff. There are times, however, when process feedback is also necessary.     

Feedback for improving staff training and performance in behavioral treatment programs

This paper reviewed observational studies that examined feedback for changing staff performance in behavioral treatment programs for clients with cognitive, developmental, or psychiatric disorders. The research findings were integrated into the main stages of staff training and management: pretraining, training, and posttraining. Specific recommendations for using feedback are made including defining process and outcome form and content before training, providing on‐the‐job supervisory feedback while staff practice self‐generated outcome feedback until competency is demonstrated, and after training, maintaining self‐generated feedback with emphasis on evaluating staff and client interactions with social validity measures. Copyright © 2008 John Wiley & Sons, Ltd.     

EVALUATING STRATEGIES TO IMPROVE CAREPROVIDER PERFORMANCE ON HEALTH AND DEVELOPMENTAL TASKS IN AN INFANT CARE FACILITY

Responding to administrative staff and parental concerns, using modified reversal and withdrawal designs, two experiments evaluated a staff-managed feedback system to improve the hygiene and developmental skills of children in an infant/toddler center. Experiment 1 examined feedback designed to increase staff performance in checking and changing diapers, and recording those changes. A chart plus supervisory feedback produced increases in and maintenance of staff performance. Experiment 2 compared an existing staff management system with a “playchart” plus feedback in increasing careprovider-infant stimulation. The data (with follow-up on a new staff) supported the use of the new feedback system. Questionnaire data further supported the utility of the playchart system.     

Staff-administered functional analysis and treatment of aggression by an elder with dementia

In the current study, nursing home staff were taught to administer functional analyses to determine the variables maintaining aggression by an elder with dementia. The results indicated that aggression was evoked during bathroom routines and that escape maintained aggression. Staff then reduced aggression to near-zero levels with noncontingent escape. Implications for the assessment and treatment of problem behaviors in nursing home settings are discussed.     

Staff management procedures and changes in the distribution of nontargeted activities by residential staff members: A secondary analysis

Staff management procedures are increasingly used to improve quality of care in residential facilities for individuals with mental retardation. Typically, residential staff members are prompted to increase and then maintain their frequency of activities within one or more target categories of behavior (e. g., training residents) and are regularly fed back on their performance. There is, however, no evidence as to what are the effects of staff management procedures on other, nontargeted activities of residential staff. Six groups of residential staff members (n=49) and 58 individuals with severe and profound levels of mental retardation participated. Observational data on staff behaviors were collected within eight mutually exclusive and exhaustive categories. When a procedure of staff management was in effect, a statistically significant increase in the time spent on the target categories of stimulative custodial care and training was associated with a statistically significant (a) increase in time spent on organization, (b) decrease in time spent on routine custodial care, and (c) decrease in time being engaged in off-task behavior. There were no statistically significant differences found with respect to staff members' time spent on housekeeping, in offering individuals recreational activities, and in taking rest.     

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.     

PREVENTING BACK INJURIES IN HOSPITAL SETTINGS: THE EFFECTS OF VIDEO MODELING ON SAFE PATIENT LIFTING BY NURSES

This study evaluated video scoring and feedback about scoring as a safety intervention among 6 nursing staff. The dependent variable was safety behavior on one‐person transfers. Following baseline, 5 nursing staff participated in an information phase. A video scoring phase was then introduced for all 6. A feedback phase was added for 2 participants. All participants experienced treatment withdrawal. Information resulted in improvements for all 5 participants who received it. Further improvements were observed during video scoring for the 5 participants who improved following information. No improvements were observed for the participant who received only video scoring. Safety feedback further improved safety for the 2 participants who received it. However, participants' behavior returned to video scoring levels during withdrawal.     

Social interaction patterns of geriatric home and community residents

Thirty elderly nursing home residents and ten community residing older adults were observed in group settings. Their behavior was assessed for dependent personal maintenance, independent personal maintenance, and appropriate and inappropriate behaviors. Responses by staff and peers to these behaviors were classified as positive, negative, or ignore. The frequency of occurrence of these behaviors as well as the relationship of resident to peer or staff behaviors were analyzed. Results indicate that community-residing elders' behaviors differ from nursing home residents' in quantity rather than quality of interactions. There was a lower frequency of behaviors in the nursing home residents. Though older adults respond differentially to various behaviors of other nursing home residents, staff responses were consistent regardless of residents' behavior. These results suggest that geriatric home residents' behavior can be characterized as withdrawn rather than dependent.     

Nursing Home Adaptation in Visually Impaired Older Adults Using a Narrative Approach1,2

This study used a narrative approach to examine the difficulties that older visually impaired people experience when adapting to life in a nursing home. The interview data were collected from one blind aged person (n = 1), focusing on the adaptation process from moving into the nursing home to the present and maintaining context of narrative that included the life history. Subcategories were extracted based on a framework of temporal coherence, causal coherence, thematic coherence, and situational coherence. This study revealed three factors related to adaptation to life in a nursing home for a visually impaired person, including psychological adaptation: becoming accustomed to life in the facility after changes in the living environment, having gratitude and maintaining “moderating human relationships,” and participating in activities connected to one's purpose in life. He was able to psychologically adapt and came to accept his death through an awareness of aging.     

A COMPARISON OF THREE STAFF-MANAGEMENT PROCEDURES

Even though administrators must have effective staff-management procedures to ensure implementation of desired programs, many traditional staff-management procedures remain unevaluated. This study investigated the effectiveness of three such procedures. The administrator of an institution for the retarded (1) sent a memo instructing all staff to lead daily recreational activities, (2) sponsored a workshop teaching staff to lead such activities, and (3) assigned staff activity leaders and provided performance feedback to staff by publicly posting the daily average number of active residents on each ward. Neither the memo nor the workshops motivated staff to lead activities, but after staff were scheduled to lead such activities and given performance feedback, the average daily number of residents engaged in activities on four wards for 95 retarded persons increased from seven to 32. The administration of this facility has adopted similar procedures to maintain such activities on all wards.