Direct observation of quality of care in residential settings

Abstract

Direct-observation procedures were used to objectively and efficiently assess several classes of service provided for individuals residing at two state facilities for the developmentally disabled. Time samples were taken of the condition of the clients' physical environment and of the clients themselves. The ongoing behavior of both clients and staff also was recorded. Each residence was observed at least three times during both regular work hours and eveningweekend hours. Results showed that both facilities scored high in the categories regarding the physical condition of the living areas, as well as the categories concerning the condition of the clients. Greater variability was seen in the data on client and staff behavior. More generally, the results indicate that time-sampling procedures can be used efficiently to collect data on multiple aspects of service delivery for large numbers of individuals.

The effects of the Positive Environment Program (PEP) on the behaviors of adults with profound cognitive and physical disabilities

“…In conclusion, the present study added to the work of other authors in the area of environmental enrichment (Haywood & Tapp, 1966;Horner, 1980;Iwata & Rodgers, 1992;Landesman-Dwyer & Sackett, 1978;Parsons & Reid, 1993;Schepis & Reid, 1994;Zarcone et al, 1993) and extends the research on what effects an enriched environment may have on adults with profound cognitive and physical disabilities. Results of the present study revealed trends suggesting that PEP serves to improve the behavior of adult residents with profound cognitive and physical disabilities and to enhance the performance of staff who provide their care.…”

“…Several studies have demonstrated the importance of enriching the environment for people with mental retardation and the positive effects that it can have on reducing maladaptive behaviors (Horner, 1980) and improving the quality of client care for persons with mental retardation (Zarcone, Iwata, Rodgers, & Vollmer (1993). Further, Parsons and Reid (1993) suggested that making materials available to individuals is one of the most favorable methods of managing active treatment in residential settings.…”

The effect of verbal and graphic feedback on the data-recording behavior of direct care trainers

“…But, in the present study, because the first author had been visible and in the environment before this project was undertaken, it is unlikely that the researcher's visibility, per se, directly affected the outcomes of this intervention, an important consideration according to Zarcone, Iwata, Rodgers, and Vollmer (1993). Both the first author and the second observer noted consistent underestimating of numbers of contingently delivered reinforcers for appropriate behavior.…”

Direct Assessment of Quality of Care in a Geriatric Nursing Home

“…For example, several observational studies of staff and resident behavior in institutions for persons with developmental disabilities have shown that, contrary to survey results, the extent of habilitative training implemented in federally funded facilities was no greater than that found in facilities without such funding (Reid, Parsons, Green, & Schepis, 1991;Repp & Barton, 1980). It has been suggested that the typical survey process may yield unrepresentative re-suits due to infrequent and subjective methods of data collection, and that more extensive and quantitative observation procedures may be necessary (Zarcone, Iwata, Rodgers, & Vollmer, 1993). Because results obtained during the survey process are frequently used as the basis for making important decisions about institutional licensing, funding, staffing, and so forth, the development of improved assessment procedures seems to be warranted.…”

“…Similarly, the physical condition of residents themselves (e.g., adequacy of grooming, freedom from injuries) is an important index of quality of an elderly person's life. Zarcone et al (1993) recently demonstrated the use of a time-sampling procedure that combined a number of the above measures. Observations were conducted several times per day in two large state residential facilities for persons with developmental disabilities.…”