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.     

Evaluation of a participatory,competency‐based model of staff training in a community habilitative setting

This study evaluated a participatory model of staff training within a community habilitative setting for adults with developmental disabilities. The objectives were to formulate an approach to training that was not time intensive, included multiple instructional methods, and incorporated all levels of staff involvement. Senior administrative, middle‐level supervisory, and direct‐care personnel comprised a committee that designed and implemented a training program that targeted performance and verbal report competencies required by ‘on‐line’ staff. Training consisted of corrective feedback, modeling, rehearsal, and practice procedures that were carried out with three individuals in a multiple baseline design across sets of target competencies. The training program was effective in establishing staff competencies although individual learning effects were revealed. The implications of these findings for the design of staff training programs within human service agencies are discussed. Copyright © 2001 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.     

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.     

A system of program evaluation and the use of feedback as a means of improving service delivery

Agencies providing services to individuals with developmental disabilities must demonstrate quality programing as evidenced through a high level of staff compliance to organizational, licensing, and accreditation standards. In addition, economic and practical considerations impose the need for cost-effective procedures for evaluating and improving staff performance. This study utilized a combination of checklists, as an evaluative tool to measure staff performance, and private feedback to improve staff performance. A multiple baseline design was used to determine the effects of providing staff with (a) orientation training, (b) task-analyzed checklists of job skills, (c) private feedback from the agency trainer, and (d) private feedback from their immediate supervisor. Results indicate that training alone does not ensure competency; checklists alone do not ensure competency; private feedback from trainers improves competency; and private feedback from direct supervisors improves competency even further.     

Training direct service staff in congregate settings to interact with people with severe disabilities: A quick,effective and acceptable program

An area of traditional as well as recent concern in congregate settings for people with severe disabilities is ensuring frequent social interactions between direct service staff and individuals who live in the residences. This study evaluated a program for training staff to interact frequently and positively across clients while in group situations in living units. The program involved a short classroom instructional session encompassing less than 1 h, followed by a maximum of 4 brief on-the-job observations and feedback sessions. Results indicated interaction rates of all 9 participating direct service staff increased above a normative criterion rate while participating in the training program. All staff also increased the proportion of their social interactions with clients that were positive in nature, and 6 of the 9 staff increased their distribution of interactions across clients. The improved interaction performances occurred when staff were provided with immediate on-the-job feedback regarding their performances as well as when provided with delayed feedback. Acceptability measures indicated the training program was well received by staff, although program components also were noted that may have affected staff acceptance differentially. Directions for future research are suggested in regard to further evaluating and increasing staff acceptance of effective training procedures.     

Use of didactic training and feedback to improve quality and acceptability of progress notes written by direct-care staff on a psychiatric inpatient unit

Writing progress notes represent a critical activity of practicing clinicians in a variety of settings. They provide a way for medical practitioners, insurance companies, and others to communicate in a timely fashion regarding ongoing clinical care. Previous research showed that intervention components like didactic training, using note templates, and feedback improved the quality of progress notes. At least two questions remain despite several studies already addressing progress note writing. First, previous research most often used multiple intervention components to improve progress notes. Thus, the relative impact of two common components of interventions, such as didactic training and feedback, is unclear. Second, previous research has not evaluated the acceptability of improved progress notes for the practitioners that actually utilize them. Thus, the purpose of the current study evaluated the components of didactic training and feedback on improved progress note writing for four direct staff employed by a psychiatric inpatient unit. A second purpose of this study was to evaluate the acceptability of the training procedures by both (a) the direct-care staff participating in this study and (b) four members of the psychiatric treatment team that used direct-care staff progress notes to inform their clinical care. Results showed that feedback was necessary to improve the accuracy of progress notes for three of four participants. The direct-care staff reported the training procedures as acceptable and the treatment team noted improvements in the quality of the progress notes after intervention. These data will be discussed in terms of ways to arrange effective training programs to improve direct-care staff's progress notes.     

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.     

The effects of behavioral skills training on mand training by staff and unprompted vocal mands by children

We evaluated the effects of a training package, including instructions, modeling, rehearsal, and feedback, for training staff members to conduct mand training with children. Experimenters collected data on staff performance on each step of a task analysis of mand training and on unprompted child vocal mands. Training resulted in increases in staff performance in mand training and in unprompted mands by children. We observed replication of these effects across settings for all staff and for 3 of the children.     

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.     

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.     

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.     

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.     

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.     

ENHANCING THE ACCURACY OF LOW‐FREQUENCY BEHAVIOR DATA COLLECTION BY DIRECT‐CARE STAFF

Accurate data collection on low‐frequency problem behavior is imperative given the paucity of opportunities to observe, record, and assess responding. Infrequently occurring behavior also provides a challenge for staff training relative to data collection. The present study evaluated the use of task clarification and feedback to teach direct‐care staff members to take data on recorded, simulated problem behavior. Results indicated that the procedures were effective in increasing accuracy not only in the contrived scenarios but also for problem behavior in the natural environment. These data suggest that task clarification and feedback on simulated problem behavior may be an effective method to increase accurate data collection on problem behavior in the natural environment. Copyright © 2013 John Wiley & Sons, Ltd.     

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.     

Reducing problem behaviors in a residential unit using structural analysis and staff management procedures: A preliminary study

A structural analysis of the problem behaviors of 32 adults with mental retardation living together in a residential facility showed that a disproportionate number of these behaviors were associated with a period of time scheduled for leisure activities. A staff management program was implemented during this time which included activity and staff scheduling, staff inservice training, and staff performance monitoring and feedback. The results showed an 83% decrease in problem behaviors when the program was implemented during the leisure period and no decrease in problem behaviors during adjacent time periods where the program was not utilized. Follow-up assessments indicated maintenance of these decreased levels of behavior at 3 and 6 months. It was concluded that this approach of combining a structural analysis with staff management procedures was effective in reducing a high level of problem behavior in a residential setting. The results are discussed with regard to pragmatic strategies for the pretreatment analysis of problem behaviors in residential settings, and the role of organizational behavior management techniques in habilitative programing for individuals with behavior disorders.     

EFFECTS OF A MULTIFACETED TRAINING PROCEDURE ON THE ACQUISITION AND GENERALIZATION OF SOCIAL BEHAVIORS IN LANGUAGE-DISABLED DEAF CHILDREN

Effects of a multifaceted training procedure were assessed on the acquisition and generalization of social behaviors with 9 language-disabled deaf children. The training procedure consisted of (a) child training and (b) supervision, feedback, and goal setting directed by teachers and residential staff. Target behaviors were turn waiting, initiating interaction, and interacting with others. Procedures to promote generality of effects and to determine the social validity of the procedures were used. Data were collected within a multiple baseline design across behaviors. Results showed a functional relationship between introduction of the training procedure and increases in percentage of appropriate target behaviors for all 9 children. The effects were maintained throughout a 5- to 10-week follow-up period.