Treatment for Youth in Short-Term Care Facilities: The Impact of a Comprehensive Behavior Management Intervention

We describe a comprehensive program to train emergency shelter staff in effective methods for dealing with youth who have behavioral and emotional problems; assess the degree to which staff implemented the treatment approach; measure the impact of the intervention on shelter-wide incidents such as out-of-control behavior, runaways, and violence against other youth; and examine pre-post changes in staff experiences at the shelter via anonymous surveys. Overall, the short-term shelter staff indicated adequate implementation of the intervention. The rate of youth incidents at the shelter significantly declined from pre to post assessment. Direct-care staff ratings of their satisfaction with their proficiency in behavior management and teaching youth skills increased significantly from pre to post implementation. These findings suggest that it is feasible to deliver an effective staff-training program to improve the behavior management and social skills of youth residing in short-term care facilities within the child welfare system.     

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.     

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.     

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.     

Effect of video self‐monitoring on procedural integrity

A video self‐monitoring treatment package was used to evaluate the procedural integrity of staff implementing behavioral guidelines for one child with autism. Staff members with low procedural integrity scores were asked to participate. The treatment package incorporated an implementation video which reviewed the relevant behavioral guidelines and a procedural integrity monitoring system. Each participant was taught to score a pre‐training video, which highlighted components of implementing behavioral guidelines, with a procedural integrity tool denoting correct implementation of the procedures. The participant then scored their own baseline video using a similar tool constructed to highlight the target student's behavior plan. Participant scores were compared to experimenter scores and verbal feedback was given by the experimenter if the scores varied. Results showed increased procedural integrity implementing the behavior guidelines from baseline to 100% implementation for two out of three participants. Copyright © 2010 John Wiley & Sons, Ltd.     

Evidence-based practice implementation and staff emotional exhaustion in children's services

Understanding the implementation of evidence-based practice (EBP) in community service settings is critical for the successful translation of research to practice. However, we have limited research evidence about the impact of EBP implementation on the mental health and social service workforce. In a previous study we demonstrated reduced staff turnover where an EBP was implemented with fidelity monitoring in the form of supportive ongoing supervision and consultation. Other research has shown that staff burnout and emotional exhaustion in particular is associated with poor quality of care and increased staff turnover intentions and turnover. Current research, however, has focused less on the effects that EBP implementation may have on staff emotional exhaustion. The present study investigates the association of EBP implementation and fidelity monitoring with staff emotional exhaustion in a statewide EBP implementation study. The 21 case-management teams in this study were randomized in a 2 (EBP vs. services as usual [SAU]) by 2 (monitoring vs. no monitoring) design. The EBP in this study was SafeCare^®, a home-based intervention that aims to reduce child neglect in at-risk families. SafeCare was developed from a behavior analysis approach and is based in cognitive behavioral principles. In keeping with our previous research, we hypothesized that providers implementing SafeCare with monitoring would have the lowest levels of emotional exhaustion and those receiving additional monitoring not in the context of EBP implementation would have higher emotional exhaustion relative to the other groups. Results supported our hypotheses in that we found lower emotional exhaustion for staff implementing the EBP but higher emotional exhaustion for staff receiving only fidelity monitoring and providing SAU. Together, these results suggest a potential staff and organizational benefit to EBP implementation and we discuss implications of the findings relative to EBPs and to fidelity monitoring.     

Integrating instructional procedures into traditional congregate care situations for people with severe disabilities

Many institutional and community residential agencies experience difficulties in providing habilitative services when direct care staff are working with groups of people with severe disabilities. We evaluated a means of assisting direct care personnel in integrating instructional strategies into traditional congregate care situations. In Experiment 1, integrated teaching strategies were operationalized for two direct care staff persons. The strategies were based on individualized client habilitative goals and the use of brief response prompting and contingent reinforcement paradigms. The staff members integrated the teaching procedures into their group routines with clients upon implementation of an integrated-teaching staff training and management program. The program involved two staff training sessions and ongoing performance feedback. In Experiment 2, four staff members in another living unit integrated the strategies into their group routines upon implementation of a simplified version of the program. Additionally, while the program was in effect, adaptive behaviors increased in frequency for 19 of 20 clients with profound multiple disabilities. Results of the experiments demonstrate a means through which residential agencies may enhance provision of continuous active treatment in accordance with clinical and governmental guidelines. Suggestions for future rescarch are provided, focusing on overcoming obstacles residential personnel face in providing treatment services in congregate situations.     

Shifting probation culture and advancing juvenile probation reform through a community‐based,participatory action research‐informed training

Many jurisdictions are currently transforming their juvenile probation systems to reflect research‐informed, developmentally based case management approaches. Training, developed through a community‐based, participatory action research (CBPAR) framework and guided by a community–academic partnership, may promote probation staff's readiness for such change. This paper examined whether such training could serve as an effective method to impact organizational culture by exploring shifts in probation staff's knowledge, attitudes, and beliefs about graduated response – a structured juvenile probation case management system that aligns with research on adolescent development and youth behavior change. Data came from 559 juvenile probation staff trained in graduated response theory and practice between 2016 and 2019. Results demonstrated that at the end of a 1‐day, CBPAR‐grounded training program, participating staff reported significantly more buy‐in to graduated response, greater knowledge of this new system, and attitudes more strongly in favor of graduated response and intended behaviors. Study findings revealed important shifts indicative of readiness for change within juvenile probation departments. Additional implementation strategies are needed to extend training gains and overcome organizational‐ and system‐level barriers to change.     

Enhancing frequency recording by developmental disabilities treatment staff

We evaluated a staff training and management package for increasing accuracy of recording frequency of problem behavior in a residential care facility. A multiple baseline design across the first and second work shifts showed that 2 of 8 participants increased their accuracy following in-service training, and all 8 improved during a condition with supervisor presence and feedback. Improvements were maintained when feedback was removed and generalized to activity periods when neither supervisor presence nor feedback was provided. Other staff behavior was not adversely affected by the intervention package.     

Psychiatric nurses' experiences with inpatient aggression

Using a survey instrument, the experiences of psychiatric nurses with inpatient aggression were investigated in East London, U.K. On this “Perceptions of Prevalence Of Aggression Scale” (POPAS), annual experiences with 15 types of disruptive and aggressive behavior were rated anonymously. Staff members were also asked to disclose the number of days missed from work due to inpatient violence. On the basis of these POPAS forms, internal consistency of the instrument, mean reported aggression frequencies, and days missed from work due to violence were calculated. Internal consistency of the POPAS appeared to be reasonable. Verbal abuse and threats were experienced by most of the psychiatric nurses during a one‐year period (i.e., by about 80–90 percent of nurses). Sexual harassment or intimidation was also experienced relatively often on an annual basis (68 percent), particularly by female and young staff members. A minority of staff members (i.e., 16 percent) had experienced severe physical violence. Although not prevalent, this type of behavior was most strongly connected with reporting sick. In particular, staff members working with involuntarily admitted patients experienced much (severe) violence during their work. Although the validity of estimates of aggression prevalence with the POPAS instrument needs to be investigated further, such a survey may be helpful in gaining insight rather quickly into the level of day‐to‐day contact with aggressive behavior. Also, since information on verbal, physical, and sexual violence, and on days missed from work, can be provided anonymously, this rather delicate, but essential management information, may be accessed relatively easily with the POPAS. Aggr. Behav. 00:000–000, 2005. © 2005 Wiley‐Liss, Inc.     

Effectiveness evaluation of the Positive Family Support intervention: A three-tiered public health delivery model for middle schools

This article presents the results of an evaluation of Positive Family Support, an ecological family intervention and treatment approach to parent supports and family management training developed from a history of basic and translational research. This effectiveness trial, with 41 public middle schools randomly assigned to intervention or control, examined student-, teacher-, and parent-reported outcomes, as well as math and reading scores and school attendance. Multilevel analyses suggested that for students at risk for behavior problems, immediate-intervention schools outperformed control schools on parent-reported negative school contacts for students at risk for behavior problems. Implementation, however, was hampered by several challenges, including school funding cuts, lack of staff time to provide parenting supports, and staff turnover. Given that preventive interventions are generally cost effective, it is critical that researchers continue their efforts to refine these interventions and find ways to support schools' implementation of evidence-based programs that can reduce problem behavior. This article is part of a special issue “Parental Engagement in School-Based Interventions”.     

Fitness of Job Type and Management by Objectives: Mediating Effects of Perception of Effectiveness and Goal Commitment and Moderating Effects of Supervisor's Behavior

Abstract : This study investigated the influence of job type (line or staff) on perceptions of management‐by‐objectives (MBO) effectiveness, goal commitment, and goal‐attainment behavior, as well as mediating effects of perceptions of MBO effectiveness and goal commitment and moderating effects of supervisor behavior. Participants were 152 employees of a factory that manufactures drugs for a Japanese pharmaceutical company. The primary duties of line personnel involved production. The duties of staff personnel who supported production included supplying materials and production planning. Results indicated that line personnel perceived MBO as a more effective system for improving individual performance and showed higher goal commitment and more active behavior related to goals than staff personnel. Although perception of MBO effectiveness was related to goal commitment, it had no mediating effect. Goal commitment mediated between job type and goal‐attainment behavior. Supervisors’ goal‐setting behavior had different positive effects on goal commitment and goal‐attainment behavior for those in line and staff positions. MBO was a better fit for line positions than staff positions. However, supervisor behavior increased goal‐attainment behavior in staff positions. The results indicated that it is important for supervisors in a business organization to operate a management system flexibly.     

Treatment of self‐injurious behavior using differential punishment of high rates of behavior (DPH)

The purpose of the current investigation was to explore the effectiveness of differential punishment of high rates of behavior (DPH) to treat the severe self‐injury of a 28‐year‐old man with autism in an adult day program setting. DPH procedures involve the use of an established criterion related to a rate of responding within some time interval at which a punisher is delivered. The implementation of DPH in this study resulted in a substantial long‐term reduction of severe self‐injurious behavior. These findings are significant in that they provide a model for the design and implementation of punishment procedures that can be adopted in applied settings where staff resources are limited. The results of this study have implications for the treatment of severe problem behavior among individuals with autism across settings and age groups.     

Stress and technological innovation: A comparative study of design practices and implementation strategies

Abstract

The implementation of new technology in the workplace is a highly problematic process. New computer systems are often associated with adverse changes in the quality of working life: raised stress levels, impaired job satisfaction, increased routinization, and so on. This article reports a comparative analysis of two projects involving the computerization of control-room operations in two ambulance services: London and Manchester. The two outcomes were strikingly different. In the London case, severe operational problems led to the abandonment of the project. In contrast, the article reports a psychophysiological evaluation of the Manchester project which showed that the new system led to both superior service levels and to reduced levels of stress. In particular, it was shown that control staff responded to high levels of workload with lower systolic blood pressure and subjective anxiety.

The contrasting outcomes of the two projects are attributed to two main sets of factors: managerial and technical. The technical design philosophy at Manchester was “user centred”; it embraced what may be called a “tool paradigm”, where the aim of technological innovation is to support and augment the role of the human operator. In contrast, the London project was highly Tayloristic, with the accent on replacing unreliable human labour by an automated system. The way the implementation process was managed at Manchester (strong leadership, user involvement) was also notably different from the London experience (weak project management, poor industrial relations). These findings suggest that human-centred principles can provide a highly effective foundation for design, but careful management of the implementation process is also required if ITprojects are to be brought to successful fruition.     

Case manager: A clinical tool for training residential treatment staff

Various behavioral approaches to institution staff training have appeared in the literature, with some showing that traditional didactic-type instruction or tangible extrinsic reinforcement is not always necessary for effective training. The system described here used principles of modeling and feedback to teach institution staff behavior management skills. In addition, staff were assigned special titles, i.e., “case manager.” Results indicate that this individualized system was associated with improvements in the target behaviors in question, and also increased the amount of time staff properly interacted with assigned residents. Implications are with regard to using this efficient approach as a clinical tool for training staff to be effective behavioral technicians.     

Adaptation to difficult designs: Facilitating use of new technology

The interface between technology and people has long been the focus of human factors engineering. The past decade has been a growth period for cognitive psychologists and computer scientists to collaborate on research and design for human-computer interaction. Psychologists in general and organizational psychologists in particular can also contribute to this work with models that capture the dynamics of technology implementation and the impact of technology on people, their work and working relationships. Strategies to support and adapt technology can affect users' evaluation of new technology. Facilitation may take the form of job aids, training, access to technical support staff, or the design of a comprehensive service, of which new technology is only one component.The work described in this article was conducted while the author was employed at AT&T Bell Laboratories.Portions of this article were presented at the 1991 Annual Convention of the American Psychological Association in San Francisco, and at a 1992 meeting of the New York Metropolitan Human Factors Society. The author wishes to acknowledge Pamela Kidder, Karen Patten and Larry Penwell for their helpful comments on an earlier draft of this article.     

Family Involvement in Residential Treatment: Staff, Parent, and Adolescent Perspectives

We conducted interviews with staff members, parents, and adolescents at a residential treatment center to examine the frequency, nature, and satisfaction with contact between parents and adolescents and parents and staff. We also assessed perceived barriers to family involvement and possible solutions for improving this involvement. Results indicated that there is more contact between parents and adolescents than in previous studies. In addition, contact between parents and staff occurred frequently, although there were discrepancies regarding their reasons for the contact. Most parents and adolescents reported that the amount of contact was adequate, but the majority of staff members perceived there to be not enough contact. Adolescents reported that there was not enough contact with secondary sources of support, most often other family members. Barriers to family involvement included transportation, parent responsibilities and personal problems, and legal issues. In addition, parents reported that strained family relationships and problematic adolescent behavior interfered with their involvement. The need for residential treatment centers to broaden services to include parents as well as members of the larger support network is discussed.     

Leadership and Social Identification in Military Units: Direct and Indirect Relationships1

This study examines some antecedents and consequences of social identification in military units. Data were collected from 2 samples in each unit: staff members and soldiers. It was found that identification with the unit was related to 3 categories of leader behavior: an emphasis on collective identity, an emphasis on shared values, and inclusive behaviors. Some of the effects of leader behaviors on members' social identification were mediated by their effects on unit culture. Some of the effects of leader behaviors on the social identification of more distant subordinates (soldiers) were mediated by their effects on the social identification of closer subordinates (staff members). Differential effects of leader behaviors on the 2 levels of subordinates were also discovered.     

Required relaxation: a method of inhibiting agitative-disruptive behavior of retardates

Institutionalized retardates frequently exhibit agitative-disruptive behavior. Recent experiments have shown that overcorrective training in specific types of behavior can inhibit inappropriate behavior. A procedure was developed in which overcorrective practice in relaxation was given to each of eight adult retardates for their disruptions. The agitated resident was required to spend a fixed period of time in relaxation in his own bed upon each occurrence of agitation. This overcorrective relaxation resulted in a rapid, enduring and almost complete reduction in such behavior as self-injury, threats, physical aggression, screaming, crying, cursing and tantrums. Ward attendants strongly preferred the required relaxation procedure to the time-out technique and other inhibition procedures they had used. The procedure appears to be about as effective as alternative techniques and to have the advantages of ease of implementation and acceptability by ward staff and retardates as a ‘reasonable’ reaction to agitation.     

Correspondence between resident- and staff-report on the QABF: Do justice-involved youth agree with residential staff?

Residents in juvenile residential treatment facilities (JRTFs) often display various emotional, behavioral, and educational needs. Researchers have recently developed behavioral interventions to increase residents' appropriate behavior such as cooperation with facility staff instructions, accepting feedback from facility staff, and tolerating unpleasant events. However, there is not a generally accepted tool for assessing the operant function of residents' problem behavior in JRTFs. For various logistical reasons, indirect functional assessments may be more appropriate in a JRTF than manipulating either antecedent or consequent events. This study obtained scores on the Questions About Behavior Function (QABF) assessment for 17 residents from two dormitory staff members for each resident. To increase the number of respondents, each resident completed a QABF for their own behavior. Results revealed moderate to high correspondence (i.e., agreement) for highest and lowest potential operant function of problem behavior between combinations of JRTF staff and residents. These preliminary findings suggest additional research with the QABF in JRTFs is warranted.