Characteristics of residential retarded clients as predictors of staff expectations and frustrations

The purpose of this study was to examine the relationship of four client characteristics—functioning level, aggressive behavior, self-injurious behavior, and attractiveness—with staff expectations of and frustration with clients. Forty staff members who worked with severely and profoundly retarded individuals served as participants. Staff members rated each client with whom they worked on the extent to which the client could behave better and learn faster as well as the level of frustration experienced in working with the client. A client's functioning level was related to staff perceptions such that the higher the functioning level, the more the client was seen as having the potential to behave better or learn faster than (s)he was presently demonstrating. Staff frustration was related to client aggression indicating that as aggression increased so did staff frustration in working with that client. Implications of the results are discussed.     

Relational dynamics between psychotherapy clients and clinic administrative staff: A pilot study

Extensive empirical research has established therapeutic alliance as one of the most stable predictors of psychotherapy outcomes. Nearly all the contemporary empirical literature on therapeutic alliance focuses on the therapist-client dyad without attending to the relational experiences many clients in outpatient clinics have with administrative staff. Literatures from the fields of social work, psychiatric nursing and milieu therapy suggest there are more systemic relational and environmental dynamics that impact treatment beyond the therapist-client dyad, although these issues have been considered primarily in inpatient settings. A relational ecology framework has been developed drawing upon relational psychoanalysis, attachment theory and symbolic anthropology to help conceptualise the broader relational dynamics beyond the therapist-client dyad that may impact a more systemic therapeutic alliance in certain outpatient contexts. In an initial cross-sectional pilot study with a sample of clients (N = 107) receiving psychotherapy at a community mental health clinic in the Northeastern United States, the present study found client ratings of both (a) the therapeutic alliance with their therapists and (b) their alliance with administrative staff each significantly positively predicted client ratings of treatment. Thus, ratings of administrative alliance predicted client ratings of treatment over and above the effects of the therapist-client therapeutic alliance. These findings provide preliminary support for further investigation of the relational ecology of outpatient psychotherapy and suggest that client experiences of relational and environmental dynamics with administrative staff may be important contributors to psychotherapy outcomes. Limitations of the present study and implications for future research and practice are discussed.     

Environmental factors in suicide in long-term care facilities.

One major purpose of this study was to identify environmental factors related to suicide in long-term care facilities. Questionnaires were mailed to a random sample of administrators at 1,080 facilities. Information was collected on facility characteristics, overt suicide, and intentional life-threatening behavior. Chi-square analyses revealed 4 environmental characteristics related to suicidal behavior and deaths from suicide: staff turnover, size, auspices, and per diem cost. More suicides occurred in larger facilities and facilities with higher staff turnover. Religious or "other" facilities experienced more suicidal deaths than public or private facilities; facilities charging less experienced more deaths.     

Severely disturbed adolescents in community care

The purpose of this research was to study key concepts related to deinstitutionalization and community facilities for emotionally disturbed adolescents. This study was conducted in two phases: In Phase I, a statewide survey was mailed to all licensed group-care providers; in Phase II, field research methods were used to collect data on five small residential facilities, each serving between four and sixteen residents. An average of 35 hours was spent observing in each facility and a total of 53 interviews were conducted with staff, residents, and administrators. Survey results indicate that a total of 125 licensed group-care agencies in Massachusetts serve 4081 residents of all ages and disabilities in residential programs. At least sixty of these facilities accept adolescents, and seventy-four of them have state approval as residential schools for youngsters with special educational needs. Findings from the field research phase indicate that small group-care facilities place an emphasis on treatment and therapeutic intervention. The therapeutic activities in five facilities share similar features, and a classification scheme based on these similarities is offered. Other findings indicate that small residential facilities are not necessarily community-based, and that living in a small facility does not ensure integration into the community. A four-point scale is presented to measure the range of possible community-oriented activities. Four origins of decision-making about community activities are noted. Other findings indicate that the facilities are characterized by a high degree of staff/resident interaction, and that they possess some characteristics of total institutions, mediatory institutions, and families; the results suggest that these facilities are a new type of social setting with no direct correlation to other types of institutions.     

Physical characteristics of residential psychiatric and substance abuse programs: Organizational determinants and patient outcomes

Described the Physical and Architectural Characteristics Inventory (PACI), which assesses the physical characteristics of hospital- and community-based psychiatric and substance abuse residential treatment programs for adults. Developed using data from 94 representative programs, the PACI has 7 dimensions that assess community accessibility, physical features that add convenience, aid recreation, and provide support for patients, and space for patient and staff functions. In comparison to community-based programs (n=63), hospital programs (n=31) had more social-recreational and prosthetic aids, safety features, staff facilities, and space. The PACI dimensions were also related to other organizational features, such as facility ownership and program size and staffing level. Programs with more physical amenities had patients who were more involved in self-initiated and community activities and were more likely to successfully complete the program and be discharged to independent living situations and paid jobs. Programs with more social-recreational and prosthetic aids, space, and access to community resources also had better patient outcomes. In addition, PACI dimensions were related to observers' ratings of facility attractiveness. Potential applications of the PACI and the full inventory of which it is a part are discussed.     

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.     

Expectation and burnout in the developmental disabilities field

Psychological burnout was assessed in staff members at workshops and community residences for the developmentally disabled. Participants also rated expectations for client progress and for their own contribution to clients. They reported on change in expectation since they entered the field. High expectations were related to low burnout; workers who reported experiencing large negative expectation change were most burned out. Burnout seemed to be prevented when staff members made an expectation shift from reliance on client progress to a sense of personal efficacy. This finding is discussed in terms of personal causation, internal control of reinforcement, and adaptation-level theory. There was little evidence of client depersonalization, a usual component of burnout. Such a burnout pattern may be a function of the ethic of community care for the developmentally disabled.     

A comparison of ready foods to institutional food

This study was conducted as a preliminary investigation of Ready Foods versus Institutional Food in a state residential facility serving approximately 500 mentally retarded residents. One administrative unit of the facility serving approximately 160 residents was used as the setting for the study. Along with residents in this unit, a variety of staff, client advocates, and volunteer workers participated in the investigation. Results were: (1) staff, client advocate, and volunteer worker responses significantly favored Ready Foods; (2) residents selected Ready Foods significantly more than Institutional Food; (3) residents displayed greater overall food waste with the Institutional Food as compared to the Ready Foods; (4) some residents displayed less choking or gagging with ready foods than with Institutional Food; and (5) out of 6 residents who were chronically overweight displayed statistically significant weight gain within one week after beginning Ready Foods and significant weight loss after the return to Institutional Food. Advantages of a Ready Foods System are discussed.     

Living with support in a home in the community: predictors of behavioral development and household and community activity

The purpose of this article was to review studies of behavioral development and household and community activity among adults with mental retardation living in community residential services and to distill knowledge about the factors that influence outcome. Research points to behavioral development occurring across the full spectrum of disability but influenced by mental retardation syndrome and the acquisition of pivotal skills. However, engagement in household and community activities has been found to be strongly related to individual adaptive behavior. People with more severe mental retardation are vulnerable to leading lives characterized by underoccupation and lack of community involvement. Moving from institutional to community-based residential services may be accompanied by significant increases in adaptive behavior, but a plateau effect on subsequent development has also been reported. There is substantial evidence to suggest that key aspects of effective teaching technology may be absent in community-based residential environments. Community settings support greater engagement in household and community activities than institutions. Ordinary housing stock and normative architecture and standards of material enrichment are to be preferred. The use of normative housing constrains group living to relatively small scale, but there is little evidence that smaller size within this range is to be preferred to larger size. There is little evidence to suggest that higher staff-to-resident ratios lead to uniformly better outcomes, but staff orientation, working methods, and performance are important influences. Little is known about what precise characteristics of community location give rise to greater community integration. MRDD Research Reviews 7:75-83, 2001.     

Therapeutic Use of Space

ABSTRACT

The project described in this article addresses the therapeutic use of physical space in an outpatient counseling facility. It was theorized that an improved facility environment could be used as a practice tool when working with a vulnerable population. The authors undertook the project with limited time and finances. The process of the change project is discussed in detail in an attempt to encourage other counseling facilities and social service agencies to consider such an effort. Related literature from varied fields is reviewed. The article also relays client and staff feedback regarding the redecorated space and addresses design considerations such as the relative strengths and drawbacks to involving clients and staff in the process.     

Macrosocial determinants of social integration: Social class and area effect

Theory and research on social support have paid little attention to the existence of important macrosocial variables determining level and content of social relationships. This study examines variations in social integration as a function of social class and residential area characteristics. Results for 234 subjects living in high and low risk neighbourhoods indicated that differences between higher and lower social class groups follow different patterns in different residential areas. Also, same social class position appeared to have different significance as a function of residential area characteristics. The levels of three social integration measures—community integration and satisfaction, community association and participation, and contribution in community organizations—were significantly higher for lower class in low risk neighbourhoods than in high risk ones. However, significant differences were found in only one measure for higher social class groups, with higher levels of community association and participation in high risk neighbourhoods than in low risk ones. The discussion examines a ‘social impoverishment’ hypothesis for high risk environments, and proposes possible protective factors for higher status residents. Relations between formal and informal sources of support, and implications for social intervention strategies are also considered.     

Architectural design of a secure forensic state psychiatric hospital

This article describes the architectural design of a secure forensic state psychiatric hospital. The project combined input from staff at all levels of the client organization, outside consultants, and a team of experienced architects. The design team was able to create a design that maximized patient dignity and privacy on one hand, and the ability of staff to observe all patient activity on the other. The design centers around 24-bed units, broken into smaller living wings of eight beds each. Each eight-bed living wing has its own private bathrooms (two) and showers (two), as well as a small living area solely reserved for these eight patients and their guests. An indoor-outdoor dayroom allows patients to go outside whenever they choose, while allowing staff to continue observing them. The heart of the facility is a large treatment mall, designed to foster the acquisition of social, emotional, cognitive, and behavioral skills that will help patients to safely return to their communities.     

Behavioral skills workshop for staff and supervisor in a community residence for developmentally handicapped adults

A behavioral skills workshop for counselors and a supervisor in a community group home was developed and evaluated. The workshop included group skills training, individual supervised in vivo practice, and supervisor training. Supervisor training taught behavioral staff management skills that were delivered in a multiple baseline design across subjects. Positive changes in staff behavior occurred for each group only after supervisor intervention. Significant positive changes occurred by the end of the workshop and were maintained at follow-up for staff self-evaluations of expertise and confidence to resolve problems, severity of client problems, and behavioral observations of positive client behaviors.     

Training community residential staff: Evaluation and follow-up

The purpose of this study was to evaluate the effect of a comprehensive residential direct-care staff training program on staff knowledge, record keeping, habilitation delivery, and turnover. A 40-hour training course was presented to 18 direct-care staff employed in three community residential facilities (CRF), while 18 staff in three other CRFs were placed on a waiting list. Sixteen of 18 trained staff (89%) increased use of habilitation activities, averaging 35.44% programming after training. Only six (33%) of the staff on the waiting list increased programming. The effectiveness of training was assessed against the gains of developmentally disabled (DD) consumers. In the training group, 31 of 36 (86.11%) residents increased on-task behavior while only 7 of 22 (31.6%) of the waiting list residents increased on-task behavior. Training also yielded improved client program records and a 50% decrease in staff turnover. Follow-up over 12 months showed behavior maintenance. Results suggest that training based on clear learner objectives, presented using behavioral procedures, and taught to the entire staff including managers improves staff performance and client benefit.     

Measuring the social climate of congregate residences for older people: Sheltered Care Environment Scale

We developed the Sheltered Care Environment Scale (SCES) to provide researchers and practitioners with a practical means of assessing the social climate in congregate residential settings for the elderly. The SCES, a 63-item yes/no questionnaire that can be completed by residents and staff members of a facility, taps their perceptions of seven dimensions of the social environment. These dimensions concern the quality of relationships, the personal growth orientation present in the facility, and maintenance and change of the social system. The SCES discriminates among settings, has moderate to high internal consistency and split-half reliability, and is sensitive to environmental change against a backdrop of relative stability over time. The SCES reflects actual, agreed-on qualities of a setting and is relatively unaffected by characteristics of the respondent. Normative data are available from a national sample of 244 facilities representing the variety of residential settings available to the elderly.     

Organization-Level Predictors of Sustained Social Movement Participation

Long‐term sustained participation represents one of the most important resources available to community organizations and social movement organizations (SMOs). The participatory literature on community and SMOs has identified a host of individual‐level factors that influence participation beyond initial engagement, and has more recently identified contextual factors that influence participation. This study builds upon current understandings of participation in SMOs by examining how sustained participation in movement activities is affected by two qualities of SMO settings: repertoire of organizational activity, and equality of staff contact with organization members to cultivate and facilitate individual participation. To this end, we employ multi‐level regression techniques to examine longitudinal data on participation within 50 local chapters of a national congregation‐based community organizing federation. We find that the conduct of organizational activities previously shown to increase levels of participation among individual persons does not necessarily lead to increases in aggregate or organization‐level participation. Further, we find that conditions of unequal staff contact among organization members represent a notable drag on organization‐level participation over time. Our findings suggest that organizers and organizational leaders may well see greater levels of participation in their organizations by simply re‐distributing resources and opportunities more equitably within their organizations.     

Occupational stress and burnout amongst staff working with people with an intellectual disability

The Occupational Stress Inventory (Osipow & Spokane, 1987) and the Maslach Burnout Inventory (Maslach, 1982) were used to assess the levels of occupational stress and burnout amongst staff providing services to people with an intellectual disability both in an institutional and community settings. Data were analyzed to determine the effects of direct client contact, staff mental health, and working environment (institution vs. community). While levels of burnout and occupational stress were not high overall, staff working in an institutional setting scores more highly.     

Clinical Expertise: A Preliminary Attempt to Clarify Its Core Elements

The recent emphasis on evidence-based practice revolves around an integration of three domains: client characteristics, relevant research, and clinical expertise. Unfortunately, most reports focus on the examination of current research, while few guidelines exist for clarifying or developing expertise in clinical psychology. Although expertise is more advanced than competence, basic clinical competence can set the foundation for the development of more sophisticated skills. It is best to strive for narrow domains of expertise instead of global ratings of a professional as an “expert”. Five criteria are proposed for evaluating, developing, and maintaining clinical expertise: (1) the professional must possess a terminal degree in the field, (2) the professional has accumulated multiple years of clinical experience in the direct provision of clinical assessment, psychological testing, or psychological treatment, (3) the professional has attained advanced credentials in a specific area of psychology, (4) the professional is visible in the professional community at a national level, and (5) the professional has demonstrated evidence of superior clinical skills in a specific application of psychology. Together, these five criteria help to objectify the evaluation and cultivation of clinical expertise in psychology. Because each criterion is weak and flawed if used alone, it is recommended that multiple criteria are used in combination to define clinical expertise.