1. PSY 6450, Unit 8 1

2.  Today and Monday: Lecture  Wednesday, no class, T-Day  Monday, 12/01: E8  Wednesday, 12/03  No lecture  Return of E8  Study objectives for ME2  Monday, 12/08: ME2, class meets at 5:00 2

3.  Odd set of materials (again)  Reid et al. (2011) published the only article that has reviewed (to my satisfaction) staff training and management programs  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) 3

4.  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 (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)

5. 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 5

6.  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 6

7.  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 7 (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)

8.  Direct care staff are often not well trained when they enter the organization  High turnover  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 8 (behavior is effervescent unlike accomplishments; need direct observation; )

9.  Large number of staff  Residential facilities require 24/7 staffing; some assisted living arrangements also require 24/7 staffing  In day training programs (centers for autistic children) still need intensive one-on-one training for consumers (i.e., verbal behavior training, functional living skills training)  Adds to the labor intensiveness for supervisors doing direct observations, performance assessments, and feedback 9

10.  The accomplishment of the staff really is the improvement 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 10 (May have to alter protocol, frequency of observations/measurement)

11.  Pay is typically low  Sometimes staff get “kicked, bitten, and scratched”  They often have little or no professional training before being hired  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 11

12. 12 (don’t blame the staff, but you can’t blame the supervisors either!) Staff need job training and support that management is often not trained to give them. What all of this boils down to for staff:

13. 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 13 (I ask you to learn these data in SO11A, but I just want to start with these data on this before moving on…)

14.  Performance management  PSY 6450, Psychology of Work  Personnel training  PSY 6440, Training  Organizational systems analysis  PSY 6510, Behavioral Systems Analysis 14

15.  Human service professionals, have little or no training in training, performance management, and organizational systems analysis, unlike business and industry  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 15

16.  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 16

17.  Supervisors in human service settings use the least effective training and management procedures  Verbal training methods (lectures and written material) rather than performance-based training methods (modeling and practice)  Antecedent interventions (training alone, memos, instructions) rather than feedback (the most common performance mgt procedure in the research; money, etc., is too expensive for human service agencies)  Punishment instead of feedback ▪ In an early study, 90% of supervisors reported they relied on punishment to manage staff performance problems (even though the available evidence indicates it is not effective) 17 ( Reid et al. make all of the points I have made about the lack of training for supervisors in their article. SOs are straightforward and on your own.

18.  Why do supervisors use the least effective staff training and management procedures?  Lack of training  Time and effort required by the effective procedures (and in the case of feedback and effective mgt procedures it is ongoing time and effort; continue to provide feedback) 18 (two reasons, always the same )

19.  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 19 (redundant – I talked about this when I introduced this unit; study objectives are straightforward – touch on some of the main points)

20. 20  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

21. 21  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)

22. 22 Experimental Phases Measures/ House BaselineIn-serviceSelf-Monitor + Feedback On-schedule A50% 80%94% B39% 75%81% On-task A28%36%72%88% B28% 77%80% (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)

23. 23  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)

24.  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 al  He is continuing his Dubai school and his consulting 24

25.  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 25 (monthly may be an adaptation to HSS because of labor intensiveness; for paperwork – often only based on clinical training, but paperwork is very important)

26.  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 26 components: Observation and feedback, $ incentives, goals/criterion for incentives, supervisory and public recognition – all of the components of an effective mgt system)

27.  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 27

28.  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 28 (He is willing to give copies of these checklists to individuals who are interested)

29.  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 29

30.  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 30 (relatively old data, 2007; training percentage is considerably higher than accuracy of books; exquisite system and and data: 75-85% of the staff are 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 )

31.  No experimental design to assess the effectiveness  But, replication across new instructors  $$ paid out has increased over the years as percentage of instructors who met criterion increased  No outcome data related to changes in learner behaviors  A system to do this is being developed 31 (Carbone has developed this list; Parsons next)

32. 32  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

33. 33  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

34. 34  Experiment 1  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”

35. 35  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 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%)

36. 36 110 Direct care staff 165 Residents

37. 37  Structure (scheduling) and reassignment of staff  Staff training  Monitoring of staff performance  Supervisory feedback 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

38. 38  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)

39. 39 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)

40. 40  The data on resident behavior collected by researchers (independent of the preceding measures on 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 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)

41. 41 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)

42. 42 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)

43. 43 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

44. 44  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?

45. 45  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)

46. 46  The authors make the point, however, that there is a disadvantage of monitoring staff behavior  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)

47. 47  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 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 said I might add something: why might feedback on resident behavior rather than on own behavior increase behavior more and be less aversive?)

48. 48 Questions on the Parsons et al. article? Discussion?

49.  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 49

50. Green, Reid, Perkins, & Gardner (1991) 50

51.  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 51 (also, very low cost intervention, and use of a lottery)

52.  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 52 (those of you who want to work in business and industry – how tough is this staff job compared to most jobs?)

53.  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 53

54.  Clear patterns for only basic care and nonwork  Only three occurrences (involving 1 staff member) of training activity were noted 54

55.  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 55

56.  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 56

57.  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 57

58.  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 58 (labor intensive!, lottery, next)

59.  Lottery ▪ Held monthly ▪ Staff were eligible if they conducted 80% of their scheduled training sessions ▪ One person’s name was selected ▪ 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 ▪ Prizes were determined based on recommendations from staff and supervisors 59 (note, low cost of prizes – very little out of pocket expense at all )

60.  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% 60 * Of observations

61.  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 61

62. Green, Reid, Passante, & Canipe (2008) 62 Final article! Almost done)

63.  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 63

64.  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 64

65.  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 65

66.  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 66 (3 of the four, supervisors, low cost!)

67.  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 67 (4 th supervisor, Mr. Davis; removal and adding stimuli the same thing in this case)

68.  Performance eligibility for lottery was determined  Lottery was held monthly  Unusual “lottery” in the sense that each eligible staff member received a prize (5 total staff)  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 68 (this may be why these staff liked the lottery better than those in the previous article; Green et al.; no losers)

69.  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 said it made their quality of work life extremely better (SO41)  All five also chose to continue the lottery (SO45) 69 (results cont. on next slide)

70.  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 ▪ Intervention: 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% 70

71. 71