Improving Residential Treatment Services: Implementation and Norm‐referenced Evaluation of a Comprehensive Management System

Abstract

Ensuring effective service delivery by direct-care personnel in institutional living units for persons with developmental disabilities historically has been a difficult process, despite considerable attention from researchers, service providers, and governmental regulatory agencies. In this investigation, we conducted a normative evaluation of the extent and quality of treatment services currently provided in residential living units (Experiment 1) and evaluated a comprehensive management system designed to improve such services (Experiment 2). Results of the first experiment, encompassing 22 living units in three states, indicated that on the average two thirds of observed resident behavior did not involve any therapeutic activity. The results also provided social validity for the criteria used to evaluate the quality of treatment provision based on opinions of mental retardation professionals. Results of the second experiment indicated that a behavioral management program implemented during 23 separate time periods across five living units was accompanied by consistent and durable decreases in resident nontherapeutic activity as well as increases in specifically designated habilitative activity. The results provide support for the successful incorporation of behavioral management technology into human service settings on a large-scale, long-term basis.

Teaching Persons With Profound Multiple Handicaps: A Review of the Effects of Behavioral Research

“…Nevertheless, we employ current criteria with which skills generally are judged to be functional in regard to meaningful educational programs for persons who have developmental disabilities (Bates, Renzaglia, & Wehman, 1981;Brown et al, 1979;Dyer, Schwartz, & Luce, 1984). The criteria to be used, although by no means a complete set of criteria for determining meaningfulness of behavior change, have received support from a variety of professional practitioners through social validity research (Parsons, Cash, & Reid, 1989;Reid et al, 1985). As discussed elsewhere (Reid et al, 1985) Evans & Scotti, 1989;Parsons, Schepis, Reid, McCarn, & Green, 1987).…”

Direct observation of quality of care in residential settings

“…Some studies have examined general activities of direct-care staff (e.g., Burgio, Whitman, & Reid, 1983;Iwata, Bailey, Brown, Foshee, & Alpern, 1976;Seys & Duker, 1986;Walbran & Hile, 1988), whereas others have focused on particular classes of staffxlient interaction (e.g., Parsons et al, 1989;Seys & Duker, 1988;Spreat et al, 1985;Vet, Allen, Chinsky, 1976). Results of these studies indicate that, although the primary job responsibilities of directcare staff are the care and training of clients, most staff time is actually spent engaged in nonclient activities (e.g., administrative work, housekeeping, staff-staff interaction, work breaks).…”

Behavior disorders among the institutionalized mentally retarded: Challenging people, challenged practices, challenged placement

“…A body of applied research has demonstrated that behavioral staff management interventions can be used to remediate these types of counterhabilitative environmental and staff performance factors. Behavioral staff management approaches have been utilized to structure and enrich client living and training environments (Horner, 1980), to improve the quality of teaching interactions (Fleming & Sulzer-Azaroff, 1989), to improve staffs provision of functional training activities (Reid et al, 1985), and to improve staffs provision of active treatment services (Parsons, Reid, & Cash, 1989).…”