Experiences in running a staff group

This study examines an activating mechanism of aggressive behaviour in young children. Many studies on attachment theories have indicated disorganised attachment as a significant risk factor for externalising problems and have explained the aetiology of disorganised attachment in terms of deficits in affect, behaviour and cognitive functions from a traumatic or inconsistent environment. Via the moment-to-moment analysis of the play therapy process with a three-year-old, this paper attempts to identify how these emotional, behavioural and cognitive factors interact in actual situations and can lead to an observable behaviour: aggressive behaviour. The findings from this study indicate that the child with disorganised attachment was going through a dual process, one with her therapist and the other with her internalised caregivers. When anxiety and an ambiguous social cue from an unpredictable situation were added to the child's repetition of previous attachment experience, this ‘click’ lowered the threshold of regulation of affect, behaviour and cognition. The child turned to disorganised and aggressive behaviour, relying on her physiological signals regarding the perceived threat. Finally, this paper describes how these difficulties can be channelled by symbolic play via displacement and containment.     

The effects of interactive staff training on staff programing and patient aggression in a psychiatric inpatient ward

Interactive staff training (IST) uses principles of organizational psychology to help line-level staff members design and implement social learning programs for severely mentally ill inpatients. IST is a training package that includes assessment of staff perceptions regarding programatic needs, selection of appropriate social learning strategies to meet these needs, appointment of a program committee from within the ward to champion development of the social learning strategy, and participative decision making about aspects of the social learning strategy. Staff on an extended care ward at a state hospital participated in IST for 15 months as part of a pilot study of its effects. Ongoing examination of ward programing showed that IST significantly increased staff and patient participation in rehabilitation programing and decreased the rate of physical restraints and aggression-related. Changes in staff attitudes about rehabilitation programing were noted on a subsample of IST participants. Implications for more controlled research into IST are discussed.     

Training staff to conduct a paired-stimulus preference assessment

Three staff members were trained to conduct stimulus preference assessments using a paired-stimulus format with 8 children with autism. Staff were trained to mastery level using brief instruction, a video model, and rehearsal with verbal feedback. Training took about 80 min per staff member. Results demonstrated that staff rapidly learned to correctly perform paired-stimulus preference assessments with children.     

Assessing the acceptability of staff management procedures to direct care and supervisory staff

Direct care and supervisory staff in five residential training programs for persons with mental retardation in North Dakota rated the acceptability of six staff management procedures. Overall, staff rated “Instructions”, “Instructions and Modeling”, “Feedback and Praise”, and “Instructions, Feedback, and Praise”, as significantly more acceptable than “Self-Management” and “Self-Management, Feedback and Praise”. There was a significant group by treatment interaction in which supervisors and direct care staff had significantly different acceptability rating for four of the six procedures. The results were further analyzed by group and implications and future research are discuessed.     

Perceptions of school psychology services from a staff perspective

This investigation examined how staff in an elementary school district perceived their school psychologists and how these perceptions differed across components of service and staff groups. We developed a School Psychological Service Questionnaire and then analyzed responses from regular education teachers, special education teachers, principals, and school psychologists in an urban school district. Although the findings are numerous, most noteworthy are, first, that consumer groups in the district had different perceptions than school psychologists about how school psychologists allocate their time and how this time should be allocated in the future. Second, consumer perceptions of school psychologists' knowledge generally were favorable. Third, in terms of domains appropriate for involvement by school psychologists, a factor analysis of consumer ratings revealed three relatively clear dimensions of recommended service provision — special education activities, interpersonal or school-climate activities, and administrative responsibilities. Fourth, the helpfulness of school psychologists, as perceived by consumers, related positively to frequency of contact. Fifth, differences in perception of school psychological services were evident across staff groups. Finally, comparisons between master's level and doctoral level school psychologists suggested numerous differences in how the staff perceived these service providers.     

Teaching medical staff psychological concepts via a hospital newsletter

Despite the increased recognition of the critical role of social and psychological factors in health and illness, the teaching of psychology is rarely integrated in medical education. Staff generally have minimal formal training in psychological concepts. Patients on the inpatient rehabilitation unit frequently present with unexpected reactions in response to acute trauma and resulting changes in identity and capabilities. Rehabilitation goals therefore, must be based on psychological, as well as physical, capacities. A one-page, user-friendly newsletter was designed to illustrate basic psychological principles via case vignettes. The topics of fear, countertransference, and resistance were selected as critical issues staff frequently encounter in their work with patients. The newsletters provided the staff with basic conceptual tools for effectively treating patients, and the work of psychologists was demystified. The newsletter format is proposed as a creative adjunct to didactic teaching.Copies of the newsletter Insight can be obtained by request from Dr. Gold.     

Adolescent sexuality in a therapeutic community: staff countertransference issues

Issues connected with sexuality such as heterosexual relationships, homosexuality, sexual identity, and seductiveness, create conflict and countertransference dilemmas for staff who work with psychiatric patients in a therapeutic community. When the therapeutic community is composed of adolescents, these issues are exacerbated since sexual identity and sexual development are major concerns. The staff reacts strongly to the issue of self-determination and violation/infringement on a basic human need. These philosophical differences have their roots in countertransference feelings. Staff sometimes find it difficult to confront adolescents on emotionally charged issues that have a sexual coloring. A system is proposed for articulating and working through these feelings. A unique solution is posited for solving this conflictual attitude (based on object relations theory), whereby the residential treatment center serves as the analog of the home in order to allow adolescents to develop a sense of self before they can move on to the halfway house where heterosexual behavior is allowed (as part of the therapeutic process). This facilitates the meeting of the "self" with the "other." This procedure is explored in light of Sullivan's concept of intimacy.     

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.     

Comparing choice and questionnaire measures of the acceptability of a staff training procedure

We compared questionnaire and choice measures of acceptability while evaluating effects of staff familiarity versus unfamiliarity with the system used to monitor performance during a training program. Staff members rated both monitoring formats equally favorably on the questionnaire, whereas when given a choice, they frequently chose the familiar format and never chose the unfamiliar format. These results suggest that traditional questionnaire evaluations may not be sufficiently sensitive measures of acceptability relative to choice measures.     

Token economy: patient and staff changes

A token economy program conducted with severely regressed, “backward” state hospital patients is described. An evaluation of the effects of the reinforcement program after one year has revealed substantial gains in patient eating, grooming, and dressing behavior and involvement in activities on and off the ward. In addition, several measures of staff attitudes toward patients evidence meaningful gains in staff expectations about the treatability of patients and the degree of the latters' psychological deficit.     

Participatory management: Maintaining staff performance in a university housing cooperative

To apply behavior analysis to normal adults in non institutional settings, we may have to encourage their participation in the design and implementation of behavioral technology. This study evaluates a technology by which the members of a student housing cooperative manage their own staff with a minimum of supervision by one of the program designers. This staff management system consisted of prompts, self-reports, spot checks, and contingent rent reductions. Six resident staff members performed substantially more of their assigned tasks when this system was used. In addition, the management system was acceptable to the members, was affordable, and maintained high levels of staff performance during a 5-year follow-up. Participation by the members in the design and implementation of this system appears to have been useful in helping the behavior analysts to develop an unusually durable management system.     

Depressed nursing home residents' activity participation and affect as a function of staff engagement

Behavioral interventions for depression target activity engagement and increased positive reinforcement, particularly from social interaction. Nursing homes provide limited opportunity for meaningful social engagement, and have a high prevalence of depression. Often residents obtain most of their social contacts from staff members. We present intra-individual correlations among positive staff engagement, resident affect, and resident activity participation from behavior stream observations of residents who were participants in an ongoing trial of an intervention for depression. Sixteen residents were observed 6 times weekly for 8 to 45 weeks, 5 minutes per observation. Positive staff engagement during the observations was significantly correlated with resident interest and pleasure. Positive staff engagement was related to resident participation in organized group activity; however, residents tended to be more engaged and show more pleasure when in informal group activities, especially those residents receiving the behavioral treatment. Positive staff engagement was not related to time in activities of daily living. Results have implications for understanding mechanisms and potential targets of interventions for depression.     

The role of direct-care staff

This article examines the current role of direct-care staff, and their significance to individuals with disabilities living in the community. The role of staff will be redefined with respect to client normalization within the community. Finally, a framework for training staff is provided.     

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.