Direct assessment of quality of care in secure residential treatment facilities for criminal offenders with intellectual disabilities

Abstract

Direct assessment was used to evaluate quality of care in 2 secure residential treatment facilities for criminal offenders with intellectual disabilities. This population and type of setting have not been previously studied in this context. Observations were conducted of environmental condition, resident condition, resident activity, and staff member activity at various times of day over a period of 3 weeks in Facility 1 and 2 days in Facility 2. An additional analysis was conducted to determine the optimal number of observations needed to obtain a representative sample. Results indicated high levels of quality in terms of environmental condition and resident condition in both facilities. Data on resident and staff activities were more variable but generally consistent with previous research.Implications for the optimal number of observations are discussed, as well as limitations and future directions for research.

Direct assessment of quality of care in an applied behavior analysis center

“…Comparing the results of this assessment with those obtained by previous assessments in other settings yields both similarities and significant differences. In Joslyn et al (), Zarcone et al (), and the current assessment, positive interaction with the resident or client was among the most frequently scored staff behaviors; the most common behavior scored by Shore et al () was nonresident work. In Joslyn et al, Shore et al, Zarcone et al, and the current study, the majority of client behavior observations were scored as appropriate social or nonsocial or “no activity”; inappropriate behavior was the least commonly behavior scored in all of the studies.…”

“…Another item that was included in previous studies but was less relevant to an ABA center was “free from injury.” In previous studies conducted at residential facilities and nursing homes (Joslyn et al, ; Shore et al, ; Zarcone et al, ), injuries were an important indicator of quality of care because clients lived at the site full‐time, and any injuries observed must have occurred on‐site. However, in an ABA center in which clients only come for part of the day, clients could have injured themselves outside of the center, which is not relevant to the quality of care provided at the center itself.…”

“…For example, future research should work to determine the minimum number of observations required to get a representative picture. The number of observations per location in previous studies has ranged from two (Zarcone et al, ) to 27 (Joslyn et al, ). Although previous studies have evaluated the accuracy of different momentary time sampling intervals up to 2‐min samples in a 60‐min session (Devine, Rapp, Testa, Henrickson, & Schnerch, ), these data do not provide a clear answer to how many intervals must be sampled across an 8‐hr work day.…”

“…In response to these types of measures, Zarcone, Iwata, Rodgers, and Vollmer () and Shore, Lerman, Smith, Iwata, and DeLeon () reported the use of momentary time sampling to assess quality of care in residential facilities and nursing homes. More recently, Joslyn, Vollmer, Dickens, and Walker () used the same procedures to assess quality of care in secure residential treatment facilities for criminal offenders with intellectual and developmental disabilities.…”

“…Shore et al () conducted observations across five areas in a nursing home and found that the cleanliness of the environment was generally high but varied across time of day, clients were generally in good condition, the majority of clients were not engaged in any activity or were engaged in appropriate nonsocial activities, and the majority of staff were engaged in nonresident work. Joslyn et al () conducted observations across two secure residential facilities and found that client condition and environmental condition were generally very high, clients were most likely to be observed engaged in appropriate activities or “no activity,” and staff were most often identified as being off‐task or engaged in resident positive behavior (Facility 1) or engaged in resident positive behavior or nonresident activity (Facility 2). Most importantly, all three of these studies showed that large facilities could be evaluated objectively and efficiently using direct observation and momentary time sampling.…”