Human Service Settings

Human Service Settings
Schedule: Wednesday and Monday: Lecture Wednesday, 11/23: No Class, Thanksgiving Recess Monday, 11/28: E7 PSY 6450, Unit 7 Human Service Settings

Human Service Settings, into
Odd set of materials (again) Wine et al. examine two types of preference assessments to determine how cash incentives compare with other types of potential reinforcers Carbone staff incentive system – only on ppt Richman et al. has (a) a very nice simple measurement system, (b) demonstrates that in-service training is not effective, and (c) self-monitoring alone is probably not effective over time (ba students work in Hss, asked if I could include low-cost interventions; usually target client training, paperwork is very important)

Human Service Settings, into
Parsons et al., model for a large scale PM and systems intervention in residential treatment facilities Green et al., a very cost-effective procedure to improve the extent to which staff conduct scheduled training sessions (structural analysis) Green et al., increasing the satisfaction of staff by altering the staff person’s most disliked staff (4 articles by Denny Reid, Carolyn Green, & Marsha Parsons and colleagues– read everything they have done, both PM and clinical; exquisite, innovative, and of the highest quality; first challenges to the direct care staff, and then challenges for the organization, but of course there is overlap)

Staff Management,intro
Staff management, while similar to OBM interventions in business and industry, offers some unique challenges Few professionals in human services are trained in staff management; rather they are trained to develop effective training and behavior management programs for their consumers Most individuals who obtain graduate degrees to work in human services end up as supervisors or managers – they do not implement the programs with the consumers themselves, rather they supervise those that do 4

Staff Management, intr0 Also, many professionals in HS manage several different units or programs and several have started their own organizations, schools, and consulting businesses but again they have no or little training in staff management or organizational systems analysis Yet, it is quite clear that no matter how well designed a training or behavior management program is, unless it is implemented correctly by staff, the consumers will not benefit Important Caveat: The relatively new requirement that BCaBAs and BCBAs whosupervise prospective certificants must have a certain number of hours in supervisory training may help solve this problem. 5

Staff Management, intro
In business and industry, it’s understood (usually) that supervisors/managers need to know how to supervise their employees and organizations promote, hire, or train employees based on that; that is not typically the case in HSS In HSS, supervisors and managers are promoted/hired because of their clinical skills It is a given that technical knowledge does not a good manager make (remember Komaki from U2) All mid- to large-size business organizations hire experts in training, performance management, and organizational systems analysis, usually in the human resources dept.; HSS have not done that A qualification: four of our OBM graduates have recently been hired into OBM jobs in HSS but that is not the norm (At WMU, over the years, no idea how many of our graduates in human services have told me that they wished they had taken all of our OBM courses while in graduate school here) 6

Challenges for the organization
Direct care staff are often not well trained when they enter the organization The relatively new Registered Behavior Technician credential being offered by the BACB is likely to help solve this problem – there is more training being offered now, particularly through third-party vendors WMU’s Autism Center of Excellence has now developed RBT training, partnered with Foxy Learning Interestingly, my colleagues who are supervisors/managers/human resource directors have been telling me that the direct care staff now often lack basic job skills (dress, attendance, getting along with others) High turnover (often 60% or higher annually (recent development; )

Critical measures are often the behaviors of the staff or clients, rather than accomplishments Implementing training procedures correctly and when scheduled, correctly responding to client inappropriate behavior Very labor-intensive as a result Large number of staff Residential facilities require 24/7 staffing In day training programs (centers for autistic children) still need intensive one-on-one training for consumers (i.e., behavior challenges, verbal behavior training, functional living skills training) Adds to the labor intensiveness for supervisors doing direct observations, performance assessments, and feedback (behavior is effervescent unlike accomplishments; need direct observation)

The accomplishment of the staff really is the improvement and/or engagement of the client Some studies measure both the behaviors of the staff and the client, but is this really feasible for an organization to do? Can you hold a staff member accountable for the progress of a particular client when each client is likely to have different individual needs? Reason why HSS organizations tend to measure the behaviors of staff – which is a very reasonable thing: should not hold an employee accountable for something that is outside his/her control In this unit, Richman et al. and Green et al. measured staff behavior while Parsons et al. measured consumer behavior One question for managers/supervisors in HSS is whether to measure staff or consumer behavior (Same issue as behaviors as critical measure; a bit redundant– expanding this a bit; May have to alter protocol, frequency of observations/measurement)

Challenges for the direct care staff
Pay is typically low Sometimes staff get “kicked, bitten, and scratched” They often have little or no professional training before being hired Again RBT training may help solve this! Job responsibilities are often not well defined after hire Often are excellent at daily care of consumers and scheduled activities (meal preparation, outings, etc.) Not given adequate training or supervision Often not given much guidance about what to do when there is “free time” for consumers 10

Challenges for the direct care staff
What all of this boils down to for staff: Staff need job training and support that management is often not trained to give them. (don’t blame the staff, but you can’t blame the supervisors either!; new supervisory training required for BCaBAs and BCBAs may help solve this) 11

SO1: The Results of Lack of Supervisor Skills in Staff Management
Research has consistently shown: Developmentally disabled individuals who live in residential facilities or group homes spend ~65% of their time off-task That is, not doing any meaningful activities or leisure activities Direct care staff who work in such facilities spend ~45% of their time off-task That is, not doing any work-related activities (Give you the references for this in the Sos; one of the most interesting things about these data is how consistent they have been – remained basically the same from the 60s to the 90s – I haven’t seen any more recent data – let’s hope this is changing!) 12

What three OBM courses should human services personnel take?
Performance management PSY 6450, Psychology of Work Personnel training PSY 6440, Training Organizational systems analysis PSY 6510, Behavioral Systems Analysis 13

SO2: State two differences between human service professionals and professionals in business that help account for staff mgt problems Human service professionals, have little or no training in training, performance management, and organizational systems analysis There aren’t experts in the organization to help them, unlike in business and industry, who hire experts in training, performance management, and organizational systems analysis in “support” units 14

SO3: Why haven’t individuals been trained in staff mgt or OBM?
Failure to recognize the importance of staff mgt Lack of availability of courses in staff mgt/OBM at the undergraduate and graduate level Very few graduate training programs in OBM OBM courses that are offered typically focus on business and industry and are marketed that way, thus students pursuing a career in human services don’t recognize the relevance of these courses 15

SOs 4-9: Wine et al. (2013) intro
Purpose Determine preferences for money relative to other types of potential reinforcers Reasons for attempting to identify other reinforcers (SO4) Cost – other items might be less expensive Money may not be available (explain) Union rules may prevent the use of money May be easier to store or deliver other items (?) Cash may be too susceptible to being stolen; all staff may not, understandably, be given access to money by the administration 16

Participants 24 direct care staff members in a group home setting Two types of preference assessments Survey and ranking 17

Two sets of items compared to $10.00 cash (SO5) Eight items that did not have a discrete monetary value Take consumers on an outing Leave 40 minutes early Extra 2o-minute break Picking a work location Eight items that had an equivalent cash value $10 convenience store gift card $10 electronics store gift card $10 donut store gift card $10 in lottery tickets 18 (one of the most interesting features of the study)

SOs 4-9: Wine et al. interesting results
Preferences were pretty consistent for surveys and ranking across both sets of items (SO6) First set: Top five preferences were the same (SO7) Second set: Four of the top five preferences were the same Provides nice reliability for both methods While cash was highly preferred in both sets across both assessment methods, other items were identified that could be potential reinforcers 19

Set 1 items in top five in addition to cash Take clients on an outing Leave 40 minutes early Extra 20-minute break Picking work location for a day Nice feature of these: No cash outlay for the organization 20 (one of the most interesting features of the study)

Set 2 items in top five in addition to cash: There are five listed because the lists were a bit different for the survey and ranking $10 convenience store gift card $10 electronics store gift card $10 donut store gift card $10 worth of lottery tickets $10 music store gift card (This result is for me one of the most interesting features of the study; begs for follow-up; although data based on averages, as I read it, most preferred cash, but some preferred the gift cards to cash) 21

SO9: Why would individuals prefer a gift card of equal value to cash?
Money obtained may be used to purchase things that are not reinforcing, but are expenses (gas, etc.) while gift cards force an individual to buy something that is a reinforcer NFE: Another reason provided by individuals in the reward profession: Once you spend money it is gone but a tangible item remains and when a person sees it, it reminds them of why they received it so you get longer-term effects (This issue is interesting to me – it may not be as interesting to you, but I know that this is is a broader issue. Many people do argue in favor of tangible rewards of equal value: both in behavior analysis and reward profession as well. Points earned and selection of item from a catalog – business built around that. Companies tend to like gift cards because they are easy.) 22

NFE: Alyce is a cash girl, not a material girl
I would argue that in most cases using the money to pay expenses typically does function as a reinforcer for most individuals I would also argue that money is much less likely to lose its reinforcing value through repeated administrations How many times will a gift card to a donut store be reinforcing? How many times will a gift card to an electronics store be reinforcing? Another problem with gift cards: the inconvenience of using them – how many of you have gotten gift cards and not used them? And how many of you have ended up paying more for items than the gift card was worth? (I can understand, however, how a gift card to convenience store would have “staying power”: Lots of items to purchase in a convenience store; back up items: point system with merchandise catalog should work as well as cash) 23

NFE: Follow-up study Add a phase in which you determine whether the items identified do function as reinforcers This has been done in a subsequent study (SO10) but cash was not included Include cash vs. point system where individuals can trade points for merchandise Perhaps some tangible items that do not have cash value Have multiple sessions with repeated administrations of each item

SO10: Comparison of three assessment methods
Three participants who worked in a group home Eight items worth $5.00, unfortunately cash was not an option Gift cards for movie rental, convenience store, restaurant, electronics store, coffee store; lottery tickets; candy of choice; and office supplies Compared survey, ranking, and multiple stimulus without placement MSWO: items placed on individual index cards. A selected item was removed, cards reshuffled, until all were selected Used in HSS when conducting preference assessments for verbal consumers (study conducted by wine, Reis, & Hantula, 2014)

SO10: Comparison of three assessment methods
Reinforcer assessment was then conducted for each participant Task consisted of completing data sheets that were typical tasks for the participants DV was the number of completed data sheets 10 minute work sessions Design 3 baseline sessions followed by multi-element design in which potential reinforcers were randomized across sessions; each was delivered for about the same number of sessions (3-6) Number of deliveries varied across participant because the number of items identified as potential reinforcers differed across participants

SO10: Results Survey identified more potential reinforcers, followed by ranking and then MSWO All items identified by the survey increased responding significantly over baseline which is important for two reasons The survey reliably identified items that did function as reinforcers Both the ranking and MSWO missed items that functioned as reinforcers Participants liked the survey more than both ranking and MSWO and considerably more than MSWO (suspicious of surveys and VB for good reason: but these data suggest that verbally fluent adults can and do identify items that function as reinforcers a priori, validating the survey; Conclusion is straightforward: these data support the survey as the best preference assessment method of the three )

SO11: Wine, Kelley, & Wilder (2014)
Examined the stability of survey and ranking assessments over time for eight items Ten employees who were technical specialists, administrative assistants, or behavior analysts Eight items each worth $5.00 (again, unfortunately, cash was not included) Coffee store gift card, lottery tickets, an on-campus dining pass, an online store gift certificate, a coffee mug, a USB memory card, tickets to an on-campus entertainment event, and a movie theater gift certificate (pretty diverse group, 23-52, high school degree – MA degree, my guess is all connected to FIT’s program in behavior analysis)

Repeatedly administered the survey and ranking assessment Assessed stability at 1-week, 2-week, 3-week, and 4-week intervals Measured how many items went from high to low and low to high preference Assessments were stable at only the 1-week interval for both the survey and ranking Preference shifts were found for 2-5 items across both methods and the other intervals (out of 8 items)

Main implication Preference for various tangible items shift over short periods of time, thus if you are using any one of them over time, it is likely, that they will lose their reinforcing value Back to why I prefer cash Cash really is the most likely tangible generalized conditioned reinforcer to retain its reinforcing value over time (Or points that can be exchanged for a merchandise or perhaps gift card for online shopping; questions, comments, agree/disagree? Ultimately, it is an empirical question: onto PM)

Richman et al. article, intro
Simple, but effective measurement system Demonstrates that in-service training is ineffective Self-monitoring alone may have immediate effects but will probably not sustain performance over time (redundant – I talked about this when I introduced this unit; study objectives are straightforward – touch on some of the main points)

Richman et al. intro, cont. (NFE)
Rationale of study To determine whether a self-monitoring procedure, with minimal supervisory involvement, could increase staff adherence to scheduled activities and on-task behavior Participants 10 staff members in two houses of an intermediate care facility (group home) for the developmentally disabled

SO12A: What two general categories of behavior were recorded?
On-schedule behavior Is the staff member in the assigned area for the scheduled activity according to the posted schedule? Does the staff member have all of the materials necessary to conduct the activity? 12B Regardless of whether the staff member was actually implementing the task (that is, the staff member could be off-task in the sense of chatting with another staff member, drinking coffee, or just interacting “generally” with the clients; as long as the person was there as scheduled with right materials) On-task behavior Is the staff member engaged in behaviors for any of the three appropriate activities (group, client/house custodial, or one-on-one training) 12C Regardless of whether the staff member was implementing the specific activity that had been scheduled (in other words, even if the staff member was doing group training when one-on-one training was scheduled; staff member ) (very nice measures of behavior, simple; apologize for the crowded slide – needs to be on one)

SO17: Self monitoring increased performance substantially
SO17: Self monitoring increased performance substantially. Why, then, was supervisory feedback added? Experimental Phases Measures/ House Baseline In-service Self-Monitor + Feedback On-schedule A 50% 80% 94% B 39% 75% 81% On-task 28% 36% 72% 88% 77% (First, note lack of effectiveness of in-service – SO16 – Not just a self-monitoring procedure – turned daily schedule cards into the Supv. at the end of the day; implication of fdbk; again; yes, they did get further increases, but the main reason -next slide)

SO17: Why add supervisory feedback?
The behavior of 5 of the 10 staff members became variable over time (that’s 50% of the participants) Supervisory feedback improved both on-schedule and on-task behavior for each of the 5. Demonstrates the importance of supervisory feedback and evaluation Also suggests that self-monitoring may be effective on a short-term basis but may not be effective long-term But, why would we expect self-monitoring to be effective over the long run? What consequences are there for self-monitoring or for the self-monitored performance? Revisit U5 on self-monitoring (question: are we doing more harm than good when we publish short term studies that indicate that interventions are Successful, particularly when the results don’t seem to conform to a solid behavior analysis? Carbone next)

Carbone staff incentive system
Carbone Clinic, center for autism 10 instructors, 2 classroom supervisors, 40 learners with autism and other disabilities, age 2-14 years In 2014, Carbone moved to FL and is no longer the head of the clinic He is continuing his Dubai school and his consulting

SO19: Overview of the bonus/incentive system
Instructors earned a monthly bonus totaling $300 a month, $3,600 per year, for exemplary performance There are two incentive components, independent $150 based on supervisor observations of training skills $150 based on accuracy of child’s program/data book Bonus is publicly announced at the staff meeting that follows the assessments Checks are given to staff at that meeting (monthly may be an adaptation to HSS because of labor intensiveness; for paperwork – often only based on clinical training, but paperwork is very important)

Overview, cont. Names were publicly posted in the staff dining room
Performance scores were referred to in the employee’s annual review Performance scores contributed heavily in determining the size of annual raises and future promotions components: Observation and feedback, $ incentives, goals/criterion for incentives, supervisory and public recognition – all of the components of an effective mgt system)

SO20: What’s so cool about this system?
Everyone who meets criterion can earn the incentive (and there is criterion/goal) Significant amount of money Public recognition at the next staff meeting Separate check – the money doesn’t get “lost” in the person’s regular paycheck Embedded in the management system – used to determine pay increases and promotions

Details: Performance observation, this slide, nfe
Following training, unannounced monthly assessments of performance were conducted Supervisor observed instructional sessions using three to four competency checklists Natural environment teaching Discrete trial teaching Teaching adaptive living skills Teaching vocal manding Implementation of behavior reduction protocols (He is willing to give copies of these checklists to individuals who are interested)

SO21: Details: Performance observation, 2nd & 3rd bullets FE
Supervisors gave vocal feedback to instructors after the observation sessions Instructors must have scored 90% on each of the 3-4 checklists used, with no critical errors to earn the incentive If instructors did not meet the criterion, supervisors coached instructors and repeated an assessment of those competencies approximately one week later

Results: Carbone incentive system, nfe
When staff were stable (no new hires) and staff were not assigned to new learners (who may have new competency checklists, thus staff is still learning the protocol): 75% to 85% of staff earned the bonus for teaching/training per month 25% to 65% of staff earned the bonus for accuracy of the child’s program/data book (relatively old data, 2007; training percentage is considerably higher than accuracy of books; exquisite system and and data: 75-85% of the staff were performing at least 90% of the checklist items correctly With no critical errors – I wonder how many other agencies can say that about their direct care staff )

Limitations: Carbone incentive system*
No experimental design to assess the effectiveness But, replication across new instructors $$ paid out increased over the years as percentage of instructors who met criterion increased No outcome data related to changes in learner behaviors (Carbone has developed this list; Parsons next)

Parsons et al. article This is the best study I have seen about a large scale OBM intervention in a human service setting The study was conducted in five group homes for the developmentally disabled In the study objectives, I point out some very useful procedures that could be implemented in any human service setting although clearly some of the details of the procedures would have to be modified Implemented a total system intervention package

Parsons intro, cont. There are two experiments
I only have an NFE SO over the first one because I wanted to focus on the intervention, but part of the beauty of this work is having the normative data from the first when analyzing the results from the second

Overview of Experiments 1 & 2
Benchmarking study on treatment and services 22 living units in six state residential facilities 18 were certified as intermediate care facilities under Medicaid (which means services can be reimbursed through Medicaid) Experiment 2 Purpose was to develop and implement a comprehensive management system to improve treatment services in five group homes Group homes were Medicaid certified Medicaid had reviewed services and the facilities had been given a time-limited mandate to improve services or face de-certification. Improvement was critical - “critical business issue”

SO22, NFE: Results of E1, benchmarking
On average, what percentage of resident behavior was off-task? 67%!! (range 0-100%) When developmentally disabled clients are in group homes, 2/3 of their time is spent doing things that do not help them. This suggests that residential facilities are not fulfilling their active treatment obligations On average, what percentage of resident behavior was active treatment? 19% (range 0-40%)

Organizational structure, staff, and residents
110 Direct care staff 165 Residents One of my purposes with the SOs is to point out the systems aspects of the program - they implemented monitoring and feedback systems for individuals at EACH level of the organization - we often intervene at the direct care staff level, but who provides PM to the group home supervisors, and to the supervisor of the group home supervisors? We forget to do that, yet are often surprised our interventions don’t last

Intervention: Four basic components (NFE)
Structure (scheduling) and reassignment of staff Staff training Monitoring of staff performance Supervisory feedback

SO24: What PM benefits are derived from scheduling and reassignment?
Reassignment and scheduling alone or in combination are common interventions in human service settings What are the benefits? Task clarification (specification of what they are supposed to be doing and when) Decreased conflict with other responsibilities Individual accountability Individuals can be identified Their performance can be measured and evaluated Their performance can be consequated (this is important – common that staff are not scheduled, everyone is just supposed to pitch in as needed; and know when it is needed)

Each staff member initialed the checklist
SO25A&B 25A How often did each supervisor or assistant supervisor observe each staff person? Once a week 25B What procedure was used to verify that the supervisor(s) observed and gave feedback to the staff member immediately after the observation? Each staff member initialed the checklist I am pointing this out because this is basically the same procedure used by Wilk & Redmon and it permits the assessment of the integrity of the intervention without observers. Remember this procedure! (these are, of course, straightforward, but I want to emphasize b)

SO26: The program director gave feedback to the area director; the area director gave feedback to the group home supervisors (NFE) The data on resident behavior collected by researchers (independent of the measures related to staff observations) were summarized and graphed, and sent to the program director weekly. The program director sent the graphs along with comments to the area director, who then sent the appropriate graphs to each group home supervisor Note two separate and independent measurement systems Were supervisors observing and giving feedback to the direct care staff How was the supervisory system affecting resident behavior - was it decreasing resident off-task behavior and increasing active training Also note that the resident behavior data were collected by: 8 staff members Student interns (number wasn’t specified) Extremely labor intensive (also the systems aspect – everyone in the hierarchy was involved – top to bottom)

SOs 28&29: Back to why the normative data from Exp1 was so important
SO28: What very nice contribution does the normative data provide when analyzing the results of the study? Most studies would have reported the improvement in resident behavior in comparison to baseline During baseline off-task behavior averaged 64%, which decreased to 41% during the PM intervention That looks like a nice decrease (23% decrease) but residents were still off-task 41% of the time (cont. on next slide)

SO28, cont. With the normative data they could also report Their baseline average was similar to the average off-task behavior in the 22 other group homes (18 of which were Medicaid certified): 64% and 67%, respectively (so maybe they weren’t doing that badly to begin with!) Not only did off-task resident behavior decrease considerably, but it is now well below the normative average, so… (in business & industry, we often call this benchmarking)

SO28, cont. Not only could the administrators and researchers show that these group homes had improved considerably, they could also show that they were doing considerably better than other state residential facilities

SO 29: Why is it important to collect normative data from a staff perspective?
Basically, so you know realistically, what good performance is given typical staff-to-resident ratios The residents were profoundly developmentally disabled, typically nonverbal, and required assistance in self-care routines The agency can only hire a certain number of direct care staff due to budgetary constraints - and usually these type of organizations are understaffed Extremely high staffing ratios: 165 residents, total staff of 127 It is simply unrealistic to assume that it is possible to have 0% off-task resident behavior - so back to the original question - what is good performance?

SO32: What is the potential disadvantage of targeting staff behavior in contrast to resident behavior? As the authors note, and I mentioned briefly earlier, while group home supervisors observed the behaviors of staff and gave feedback to them weekly immediately after the observations, neither staff behavior nor supervisor observation behavior were graphed and fed back to supervisors or staff Rather, the feedback that was given was feedback on the % of off-task resident behavior and % of time residents were involved in active treatment To truly determine a functional relationship between staff and supervisor behavior and resident behavior, you would have to measure both (however, I admit I am convinced by the data)

SO32, cont. The authors make the point, however, that there is a disadvantage of monitoring staff behavior (answer below for SO32) Maintain that staff frequently do not like to be observed and often react negatively - from mild nervousness to out right hostility But, they do not react as negatively when resident behavior is monitored and reported Thus, this may have made it more likely that supervisors would continue to use the system It’s an interesting point - but I don’t know how valid it is I looked at the reference given, but it was to a book written by Reid et al. for practitioners, and no data were provided It would be an interesting (but difficult) study to conduct (cont. on next slide)

SO32, Babcock et al. However, Babcock et al. (1992) found that the performance of nurses was better when they were given formal feedback on the accomplishment measure for the staff (wearing gloves when removing soiled sheets), rather than on their own behavior of giving feedback to staff So, there are some data to back up Reid et al. It’s a interesting issue and question, that is Do you give individuals feedback on their behavior or Do you give individuals feedback on an accomplishment measure? Is there a difference in performance and satisfaction of the workers? (NFE, but why might feedback on resident behavior rather than on own behavior increase behavior more and be less aversive?)

Questions on the Parsons et al. article?
Discussion?

Maintenance of PM interventions: NFE but very, very important
We know we can get short-term improvements in performance How do we get maintenance? There is only one sure way: PM must be embedded in the management system Human service settings tend to emphasize only client service and goals to the exclusion of PM programs

Application of a structural analysis to staff management
Green, Reid, Perkins, & Gardner (1991) Application of a structural analysis to staff management

Green et al., introduction
This article presents a very nice objective assessment of the barriers that can interfere with the implementation of training programs in human service settings Also, it is sensitive to the staff Staff had been complaining they didn’t have time to do training Instead of “dismissing” their complaints, Green et al. collected data that could help solve the problem That is, when were staff available to do training and when weren’t they because of their competing job responsibilities (also, very low cost intervention, and use of a lottery)

SO33: Structural analysis
Study was conducted in a residential facility for individuals with profound handicaps Collected data to determine staff behavior patterns during the work day – when were they busy and when did they have “down” time Participants were 4 direct-care staff assigned to the day shift 20 clients Profoundly mentally retarded, non-ambulatory, serious medical complications, histories of non-responsiveness to behavior-change programs (those of you who want to work in business and industry – how tough is this staff job compared to most jobs?)

SO33: Structural analysis
Five DVs Basic care General interaction Training Indirect basic care Nonwork Observations Time-sampling procedure, every 15 minutes, on weekdays 7:30 – 11:15 am 1:15 – 3:00 pm 96 total observations over 26 days

Results, NFE Clear patterns for only basic care and nonwork
Only three occurrences (involving 1 staff member) of training activity were noted

SO34: Results (FE) In the morning
The number of staff members engaged in direct basic care was greatest during the earlier time periods and decreased as the morning progressed Conversely, the number of staff engaged in nonwork increased as the morning progressed 10:30-11:00 am appeared to be the optimal morning time to increase structured client training activities without interfering with basic care

More Results, but NFE In the afternoon
Similar pattern, but direct basic care was much less frequent Nonwork was most frequent from 2:00-2:30 pm, with no observations of basic care during that period 2:00-2:30, thus was an optimal time to attempt to increase client training

NFE, Experiment 2 overview
Scheduled training at 10:30-11:00 am 2:00-2:30 pm 4:00-4:30 pm added to provide a more comprehensive evaluation staff mgt program – different staff members were working Measured direct basic care and training during those time periods

NFE: Multi-component intervention
Staff training, first Staff management, next; four components Daily verbal feedback provided to each staff member contingent on the occurrence and proficiency of client training activities Private weekly feedback provided to each staff member Self-recording; each staff member initialed a chart posted in the living unit each time he/she conducted a training activity with an assigned client (labor intensive!, lottery, next)

SO36 FE: The lottery system, 4th component
Held monthly Staff were eligible if they conducted 80% of their scheduled training sessions One person’s name was selected Prizes were determined based on recommendations from staff and supervisors Prize, could select a special privilege from a list, i.e., Free lunch Extra 30 minutes for lunch or leave 30 minutes early from work Private parking space A written commendation letter to be placed in his/her personnel file (note, low cost of prizes – very little out of pocket expense at all )

SO37, NFE, Results were terrific!
2:00-2:30 Nonwork decreased from 93% to 8%* Training increased from 0% to 91% 10:30-11:00 Nonwork decreased from 27% to 2% Training increased from 7% to 86% 4:00-4:30 Nonwork decreased from 18% to 5% Training increased from 0% to 84% * Of observations

NFE, Lottery Remember, lottery was held only monthly
Authors did not indicate # of staff who were eligible in each (which would have been nice to know) 8 staff members 4 from the morning shift and 4 from the afternoon shift If all staff met the eligibility criterion (which probably did not happen), each staff member would have had a 1 out of 8 chance of winning Looks like pretty good odds

Improving supervisor work enjoyment
Green, Reid, Passante, & Canipe (2008) Improving supervisor work enjoyment Final article! Almost done)

Green et al., introduction
I like this article because of its emphasis on increasing the work satisfaction/enjoyment of supervisors in a human service setting They have very difficult jobs and this is one of the few articles (if not the only one in our field) that has directly addressed that issue

Green et al., overview Purpose:
Increase work enjoyment/satisfaction of supervisors by identifying their most disliked task and making it more attractive DVs Repeated preference ratings and rankings During baseline to identify most disliked tasks After changes to determine if preferences had changed Survey after intervention 7-point scale, did the intervention make their quality of work life better or worse Did they want to continue the intervention In one case a lottery was implemented for staff, so the staff were surveyed with respect to whether they wanted the lottery to continue Objective measures of work quality on the targeted tasks

NFE: Most disliked tasks
Ms. Tome and Ms. Jones: completion of monthly progress notes Ms. Noel: reviewing time sheets Mr. Davis: conducting staff observations because it appeared that the staff did not like having their performance reviewed

SO43: What made the tasks aversive and how were they changed?
Completion of monthly progress notes and review of time sheets (3 of the 4) Frequent interruptions! How was this changed? Removed disliked stimuli Scheduled a specific time in an office away from their work stations; an office that their staff did not have access to Added liked stimuli Provided them with snacks and bottled water when they were doing the task (3 of the four, supervisors, low cost!)

SO44: What made the tasks aversive and how were they changed?
Observation of staff’s performance (1 of 4) Staff didn’t seem to like it How was this changed? Removed disliked stimuli/added liked stimuli Added a performance lottery; described as a means for making observations more pleasant for staff (4th supervisor, Mr. Davis; removal and adding stimuli the same thing in this case)

SO45, unusual lottery system
Performance eligibility for lottery was determined Lottery was held monthly Unusual “lottery” in the sense that each eligible staff member received a prize As each name was called, the winner selected the prize he/she wanted from a list of available items Prizes Gift certificates from local stores, re-arrangement of some work duties, and changes of some aspects of their work schedules (this may be why these staff liked the lottery better than those in the previous article; Green et al.; no losers)

SO 45: Results Preference ratings and rankings increased substantially for the targeted tasks for all 4 supervisors All four chose to continue the program All 5 of the staff who reported to Mr. Davis and who were surveyed said it made their quality of work life extremely better (SO41) All five also chose to continue the lottery (SO45) (results cont. on next slide)

Results, NFE, cont. Work quality measures: remained high Ms Tome
Baseline: 98% correctly completed progress notes Intervention: 100% correctly completed progress notes Ms Jones Baseline: 100% correctly completed progress notes Ms Noel (ratings by supervisor re time sheets) Baseline: outstanding Intervention: outstanding Mr. Davis Baseline: completed 80% of the observation forms Intervention: completed 100%

THE END!

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Human Service Settings

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Presentation on theme: "Human Service Settings"— Presentation transcript:

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