INCREASING NURSES' USE OF FEEDBACK TO PROMOTE INFECTION-CONTROL PRACTICES IN A HEAD-INJURY TREATMENT CENTER

This study established regular implementation of a simple feedback procedure by supervisory nurses with their assistants at a head-injury treatment center. Five nurses were trained to distribute brief written comments to their assistants about infection-control practices, including using gloves to avoid contact with body fluids. Following low rates of written feedback, nurses met with the trainer weekly to set goals for using the system, to review feedback rates, and to examine contingent letters of appreciation. Written feedback increased from 0.09 to 0.58 per day. When outcome data on glove use were subsequently added to the feedback provided to nurses, nurses' feedback on glove use increased and overall glove use by assistants increased by 36.7% for 66.7% of assistants who responded to feedback. Assistants rated feedback as highly accurate and indicated some interest in receiving future feedback. However, nurses and assistants expressed a preference for oral over written feedback.     

SOCIAL SKILLS TRAINING WITH CHILDREN: PROCEED WITH CAUTION

Three learning disabled children, selected on the basis of peer sociometric ratings and teacher referral, received social skills training. A group training procedure consisting of coaching, modeling, behavior rehearsal, and feedback was used to teach children the target behaviors of eye contact and appropriate verbal responses. A multiple baseline analysis across target behaviors was used to demonstrate treatment effectiveness on role-play scenes trained during treatment sessions. Duration of speech was measured as an untrained, corollary measure. The following measures were also obtained during baseline, posttreatment, and 1-mo follow-up for the experimental subjects and three control subjects: (a) performance on role-play scenes not trained during treatment sessions; (b) behavioral observations in a free play setting, and (c) sociometric ratings. In addition, the trained and untrained role-play scenes were administered by novel experimenters following treatment. The results indicated that socially unskilled, learning disabled children can be taught to respond appropriately to role-play situations. However, improved performance did not generalize to the natural school setting and treatment did not effect ratings of peer acceptance. The implications of these findings for future social skills training with children are discussed.     

Comparison of grasping movements made by healthy subjects in a 3-dimensional immersive virtual versus physical environment

Virtual reality (VR) technology is being used with increasing frequency as a training medium for motor rehabilitation. However, before addressing training effectiveness in virtual environments (VEs), it is necessary to identify if movements made in such environments are kinematically similar to those made in physical environments (PEs) and the effect of provision of haptic feedback on these movement patterns. These questions are important since reach-to-grasp movements may be inaccurate when visual or haptic feedback is altered or absent. Our goal was to compare kinematics of reaching and grasping movements to three objects performed in an immersive three-dimensional (3D) VE with haptic feedback (cyberglove/grasp system) viewed through a head-mounted display to those made in an equivalent physical environment (PE). We also compared movements in PE made with and without wearing the cyberglove/grasp haptic feedback system. Ten healthy subjects (8 women, 62.1 ± 8.8 years) reached and grasped objects requiring 3 different grasp types (can, diameter 65.6 mm, cylindrical grasp; screwdriver, diameter 31.6 mm, power grasp; pen, diameter 7.5 mm, precision grasp) in PE and visually similar virtual objects in VE. Temporal and spatial arm and trunk kinematics were analyzed. Movements were slower and grip apertures were wider when wearing the glove in both the PE and the VE compared to movements made in the PE without the glove. When wearing the glove, subjects used similar reaching trajectories in both environments, preserved the coordination between reaching and grasping and scaled grip aperture to object size for the larger object (cylindrical grasp). However, in VE compared to PE, movements were slower and had longer deceleration times, elbow extension was greater when reaching to the smallest object and apertures were wider for the power and precision grip tasks. Overall, the differences in spatial and temporal kinematics of movements between environments were greater than those due only to wearing the cyberglove/grasp system. Differences in movement kinematics due to the viewing environment were likely due to a lack of prior experience with the virtual environment, an uncertainty of object location and the restricted field-of-view when wearing the head-mounted display. The results can be used to inform the design and disposition of objects within 3D VEs for the study of the control of prehension and for upper limb rehabilitation.     

A SELF-INSTRUCTIONAL PACKAGE FOR INCREASING ATTENDING BEHAVIOR IN EDUCABLE MENTALLY RETARDED CHILDREN

The purpose of this study was to develop a self-instructional package that would aid highly distractible retarded children in increasing their attending behavior in a training and two generalization (a one-to-one and a classroom) situations. Three untrained subjects were monitored for general comparison and social validation purposes. One of these control subjects was distractible and the other two (criterion comparison) were evaluated as not having attentional problems. A multiple baseline design was employed in which training was sequentially introduced across subjects. During training, the experimental subjects were taught through self-instruction to focus their attention and to cope with two tasks, math and printing. After learning the self-instructions the subjects were systematically and sequentially exposed to photo-slides of distracting situations, to audio-distractors composed of noisy lunchroom verbal peer interactions, and to in vivo distractors provided by kindergarten children playing with wooden blocks in the training setting. The entire training procedure was handled in a game-like context to maintain subject interest and to facilitate generalization. The results suggested that the training package produced direct and generalized changes in self-instructional behavior. In addition, a decrease in off-task behavior occurred during math, printing, and also during a phonics program in the one-to-one and classroom situations. However, reliable changes in academic task performance were not observed. Finally, no systematic changes on any of the dependent measures occurred for the three untrained subjects.     

THE EFFECTS OF PERFORMANCE FEEDBACK ON THE SAFETY OF CLIENT LIFTING AND TRANSFER

Individual written and verbal performance feedback was examined to determine its influence on the safety with which physically disabled clients were transferred. Two client-transfer techniques were task analyzed and six direct service providers' on-the-job performance was measured weekly. A multiple baseline across settings and subjects was used to evaluate effects of the feedback. Consumer satisfaction and the costs of the procedures were also assessed. Results showed that feedback was consistently followed by improvements in safe performance. These improvements tended to maintain as feedback was faded. Participants favorably rated the feedback procedure and consistently recommended its use with other staff.     

Manual performance in the cold with gloves and bare hands

Previous research aimed at quantifying and reducing the decrements encountered in performing manual tasks in cold weather has not described the relationships between task characteristics and cold-induced impairments. The amount of decrement and, often times, the optimal means for reducing the decrement, appear to be task-specific. The research reported here is one in a series of studies formulated to explore those relationships. The strategy is to use tasks from the battery developed by Fleishman (1967) to measure the factorially 'pure' abilities needed to perform all manual tasks. 24 U.S. Marines performed this battery of nine tasks across a range of cold temperatures. To determine if the decrement due to wearing gloves might be less than the decrement due to cold hands as the air temperature decreased, performance on the battery of tasks was measured with and without gloves. Only three of the tasks (abilities) were affected by cold temperatures, and the amount of decrement increased as the air temperature decreased. Three tasks deteriorated due to wearing of gloves, two of those affected by cold and one other. Temperature affected performance independently of the glove effect. Half of the subjects did not complete bare-handed testing at -18 degrees C (approximately 20 min.), indicating this is the lower end of the temperature range in which bare-handed performance for more than a few minutes is practical.     

The effects of response effort on safe performance by therapists at an autism treatment facility

The effects of response effort on safe behaviors (i.e., glove wearing, hand sanitizing, and electrical outlet replacement) exhibited by therapists at an autism treatment center were examined. Participants were exposed to 2 or 3 levels of effort (i.e., high, medium, low) for each dependent variable. Results showed increased safe performance during the low-effort conditions relative to other conditions across all dependent variables for all participants.     

A Field Study of the Effects of Gradually Terminated Public Feedback on Housekeeping Performance1

Recent studies have shown that more feedback is not always better. A multiple baseline across‐groups design was used to assess the impact of infrequent (at gradually increasing intervals), publicly posted housekeeping feedback on the housekeeping level. The housekeeping performance of 3 road maintenance areas and I garage was monitored over a 6‐ to 17‐month period. The increases in performance were equivalent to studies giving more frequent housekeeping feedback at a fixed‐interval schedule. The length of feedback interval was not significantly correlated to the change in housekeeping index. The results suggest that after a learning period, the frequency at which feedback is provided may not be a critical factor. The appropriateness of feedback frequency may be affected by learning level (i. e., the information value of feedback at that particular time).     

A behavioral analysis of incentive prompts for motivating seat belt use

The seat belt usage of drivers was observed at the entrance to two campus parking lots during morning arrival times. After 11 days of baseline, fliers which prompted seat belt wearing were handed to drivers of incoming vehicles. At one parking lot all fliers offered a chance to win a prize (noncontingent rewards); while at the second lot only those fliers given to seat belt wearers included a chance to win a prize (contingent rewards). After 24 consecutive observation days, these interventions were removed for 14 days of withdrawal. The recording of vehicle license plates enabled an analysis of belt usage per individual over repeated exposures to the experimental conditions. At the lot with the contingent reward intervention, mean belt usage was 26.3% during baseline, 45.7% during treatment, and 37.9% during withdrawal. At the noncontingent reward lot, the mean percentage of belt wearing was 22.2% during baseline, 24.1% during treatment, and 21.8% during withdrawal. The analysis of repeated exposures per individual verified that only contingent rewards influenced substantial increases in belt wearing, and showed that most of the influence occurred after the initial incentive prompt.     

Reciprocal peer management: Improving staff instruction in a vocational training program

To test the feasibility and utility of involving peers as sources of feedback, 6 subjects, instructors in a vocational program for adults with mental retardation, participated in a staff training and management program. Subjects' teaching interactions were assessed during baseline, in-service training (on effective teaching), return-to-baseline, peer management, and follow-up phases. Peer management was introduced in multiple baseline fashion across pairs of subjects. Members of each pair were trained to monitor peer teaching, to record and graph data, to provide feedback, and to set goals with the peer. Each pair then performed these procedures on the job for several weeks, during which time 4 of the 6 subjects increased their use of effective teaching methods (over baseline). However, inconsistencies in the magnitude and durability of these increases require that the study be viewed as inconclusive, although it has heuristic value as a promising model for involving co-workers in staff management programs.     

Evaluating video modeling and video modeling with video feedback to enhance the performance of competitive dancers

This study evaluated the use of video modeling and video modeling plus video feedback to enhance four adolescents' performance of a dance movement. Intervention was evaluated in a multiple baseline across participants design. This study found that video modeling enhanced performance from baseline, but the addition of video feedback produced further increases. For one participant, improvement was dependent on the perspective of the video model. Implications of these findings and suggestions for future research are discussed.     

Hormonal changes of intimate partner violence perpetrators in response to brief social contact with women

This study investigated whether men with a history of real-life aggressive, dominant behavior show increases in testosterone and cortisol levels after brief social contact with women. Furthermore, we tested the prediction that such changes in hormones would be larger than those observed previously in young male students. Sixty-seven male participants convicted of intimate partner violence (IPV) either had brief social contact with a female confederate (experimental condition) or a male confederate (control condition). We also performed meta-analyses to investigate whether IPV perpetrators' hormonal responses were larger than the typical responses of young male students in prior studies. All statistical analyses were preregistered. Change in testosterone did not differ across experimental conditions, and testosterone in the IPV perpetrators actually declined from baseline in the female confederate condition. Our meta-analysis showed that this testosterone decrease was different from the testosterone increase typically observed in young male students. The cortisol levels of IPV perpetrators did not change in response to contact with women. This result was consistent with our meta-analysis since young male students also did not experience a cortisol change in response to interactions with women. In sum, our findings provide no evidence that male IPV perpetrators exhibit larger hormone increases to brief interactions with women, although it is possible that the men in this sample did not perceive the social contact period as a courtship opportunity. These results suggest that hormone reactivity to social encounters may differ across subject populations and depend on how subjects perceive social situations within laboratory settings.     

STIMULUS (INSTRUCTIONAL) FADING DURING EXTINCTION OF SELF-INJURIOUS ESCAPE BEHAVIOR

Three individuals with developmental disabilities were exposed to a series of assessment conditions to identify the source of reinforcement for their self-injurious behavior. In each case, self-injury occurred most often in instructional (demand) situations containing a brief time-out from the task contingent on self-injury, indicating that the behavior was an escape response (i.e., maintained by negative reinforcement). Treatment was implemented in a multiple baseline across subjects design and consisted of extinction (prevention of escape) plus instructional fading (initial elimination of instructions followed by their gradual reintroduction). Results showed that the combined treatment produced immediate and large reductions in self-injury that were maintained as the frequency of instructions was increased across sessions to match the original baseline rate of presentation. Results of a component analysis conducted with 1 subject suggested that stimulus fading accelerated the behavior-reducing effects of extinction.     

Using a taped intervention to improve kindergarten students' number identification

A multiple baseline design across students was used to evaluate the effects of a taped numbers (TN) intervention on the number‐identification accuracy of 4 kindergarten students. During TN, students attempted to name the numbers 0 through 9 on randomized lists before each number was provided via a tape player 2 s later. All 4 students showed immediate increases and reached 100% in number‐identification accuracy. One student reached 100% accuracy after TN was supplemented with performance feedback, reinforcement, and overcorrection.     

INDUSTRIAL SAFETY HAZARD REDUCTION THROUGH PERFORMANCE FEEDBACK

A “feedback package” system, designed to prevent occupational accidents and to fit directly into the normal operations of an industrial organization, was analyzed. Eighteen hazardous conditions in six production departments were assessed during seven observation sessions over a 12-week period, plus four follow-up observations over 4 months. The “feedback package” was presented in multiple baseline fashion, across subjects (department supervisors). It consisted of presenting the supervisor with copies of observational data, accompanied by a note which congratulated good practices and suggested ways for improving safety conditions, along with occasional comments from a senior executive. The results indicated that during the feedback phase, hazard rates were lower and less variable than during the baseline phase. Baseline data were highly variable with peaks ranging from 20 to 55 hazards per department. Following intervention, hazard frequencies dropped by 60%, averaged across departments, with decreases ranging from 29% to 88%. During treatment, data stabilized, with the highest frequency reaching 33. A modified feedback system was implemented by the organization following termination of the study, validating the assumption that such a system would tend to maintain.     

Evaluating a more cost-efficient alternative to providing in-home feedback to parents: the use of spousal feedback.

We evaluated the contribution of spousal feedback to a parent education curriculum designed for parents of children with autism. A modified multiple baseline design across 3 husband-and-wife dyads was used to examine the effects of teaching parents to give each other feedback on their teaching performance. For 5 of 6 participants, improvement in teaching performance occurred following didactic presentations. However, additional improvement was observed for 5 participants when the spousal feedback component was implemented.     

Home-based reinforcement: Behavioral covariation between academic performance and inappropriate behavior

This article describes the effects of a home-based reinforcement program on the academic performance and inappropriate behaviors of 3 fourth-grade boys. Home contingencies were placed on only academic performance. The home-based system resulted in marked increases in academic performance and large decreases in disruptive behavior for all three subjects. Throughout baseline and treatment conditions, there was a strong negative correlation between academic performance and disruptive behavior. The intervention was evaluated using both visual inspection (multiple baseline across subjects) and interrupted time-series analysis.     

Task clarification, performance feedback, and social praise: Procedures for improving the customer service of bank tellers

Customer service for bank tellers was defined in terms of 11 verbal behavior categories. An audio-recording system was used to track the occurrence of behaviors in these categories for six retail banking tellers. Three behavior management interventions (task clarification, performance feedback, and social praise), applied in sequence, were designed to improve overall teller performance with regard to the behavioral categories targeted. Clarification was accomplished by providing clear delineation of the various target categories, with specific examples of the behaviors in each. Feedback entailed presentation of ongoing verbal and visual information regarding teller performance. Praise consisted of verbal recognition of teller performance by branch managers. Results showed that clarification effects emerged quickly, producing an overall increase in desired behaviors of 12% over baseline. Feedback and praise effects occurred more gradually, resulting in overall increases of 6% and 7%, respectively. A suspension of all procedures led to a decline in overall performance, whereas reinstatement of feedback and praise was again accompanied by performance improvement. These findings extend the generality of behavior management applications and help to distinguish between possible antecedent and consequent effects of performance feedback.     

Learned helplessness and learned resourcefulness: effects of noncontingent success and failure on individuals differing in self-control skills

We designed two experiments to investigate the role of self-control processes in learned-helplessness studies by assessing the differential reactions to uncontrollability of subjects who presumably had either a rich (high resourceful, or HR) or poor (low resourceful, or LR) repertoire of self-control skills. HR and LR subjects received noncontingent success feedback, failure feedback, or no feedback on a task that ostensibly assessed "therapeutic abilities." Subjects were subsequently tested on insolvable puzzles (Experiment 1) or on solvable anagrams (Experiment 2). According to Kanfer and Hagerman's (1981) self-regulation model, self-regulatory activities are evoked primarily in situations in which subjects are faced with repeated failure. Hence we predicted that individual differences in self-control would influence performance on the insolvable puzzles and not anagram performance after exposure to noncontingent failure. This prediction was confirmed: Only the performance of LR subjects on the insolvable puzzles was debilitated by the helplessness induction, whereas HR and LR subjects showed equal helplessness-induced deficits on the anagrams. The latter finding was interpreted in terms of the learned-helplessness model without the mediating effects of self-regulatory processes. As predicted from the self-control model, HR subjects more frequently checked statements indicating positive self-evaluations and task-oriented thoughts and less frequently checked negative self-evaluations than did LR subjects during exposure to uncontrollability in both experiments. We concluded that the self-control model accounts best for subjects' self-reactions during exposure to uncontrollability or failure, whereas the learned-helplessness model accounts for the generalization of helplessness from uncontrollable situations to controllable ones.