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'I , AVIS

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La'quell" d'lmPres$ioll-de c:ertaines'Palinpeut

taine'• desiret'o .urtou tIi Inpagesorigin~.ont

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dac:tylogr.phIMs • I'.kled'u ntubanlI5II!ou,i.'u niver-

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qual iw." , . - .

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sont pas miQ'ofilmis.' • • .,

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.".NOTICE

. ReproductionillNil or in-PW1 ofth~filmIsgaY- ernedbytheCanadianCopyrightAct.A.S.C.1970-

•c.C30.Pl. _ ra.clthe'authoriution fotm .whidl a~y ttl;.thesis" .

.. ...

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.Th~,qu. lil v01this miQ'Of,ichei.he~i1YdepfiJdenl upoI'\lh equeUty of theorlgi n81th~ i submitt&dfor microfilming.Enryeffo rt1:18.beenimide-to ensure thithlghes,qu.IIW 0'ref)roductioripossible. •

IIP'c1Jll1',rt'miuing,contacttheunlv.rs ltvwhlch

grentedthedegree. . - .

' ~me pa~

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indi stinct pr;nt

~,pecie.UY

1 :

Iftheorlgin , l pageswere typed with . poortypewr iter

l · ¹ '-''''"-",- ,-- ...

I i

,THI SDISSERTATI ON HAS BEEN MICROFILM ED"

, ,EXA CTLY.ASRECEI V ED

. /

. ·LATHtSEA ET E : . MICROFILME E TElLE QUE. .:.NOU SL'A V ON SREeV E.. ·

I i

r ""'• •

eo....

r ...- -

L ---

...•:.

- !J

···THEEFFECTSOF:TWO'smes"OFFEEDBACKOliSTA FF'S

'TA~1C cO~L"ETION

^{INATo i EN}

ECO~MY"PROGRAM

by:'

.'

-

. . "

.Ed~~T·J~.5eph-Gaulton . B-.se.

A,Thu i5"·S:~bJJli7ted,in'part i al£~l.£ilblenl

;0 £the.r equdre e ent s for the deg r eeof

Maste rof Sc ienc e

- 1. . .

i

Depax:tJllent o~<PSyc~ology Me";orial'U~,i~ersityof Newfou~dland

~

...'.S"t.,',John:'s'.

~Aug us t 19 79 ...:.

Newfoundland

.. t ···.

.• .. . .. t.

A ..:

· ·L·

ABSTRACT.

....~.;:

... . -;-:-

'.

⁾

l

. .·· 1 ,

.-

.

^.

.1

i.· •.

\

emthe't~rg etbehav i our s..Pee dba c k cond itio ns.w~r'e.16days

~.ong. ,and ' ~t~e

ba s el in e'and'

withdraw~l

^.: pnd i t i ons.

~eTe

²⁰

,day s"e ac h;

R'esu~ts

^s,howedthat

ASSist~'Jlts

.:'.c ompl e ti on_OfaSSi'gn e d tasks"inc r e a s ed,· in'the"fourexper~lIenta lphas e s'.

.

(tw oki~d s .'er:feed bac k ):r~la,t-iv~,to, baseliil.e.and:~l.thdrawa.l'Ph~s e_s:

.'The.'dif.f~rence s~eresUfficie~t;t~s.up po r -t'the co~cl us i on

that.

b~th,

^kinds'

.~£

feedbac k:'

Pl'~d~c~d i;n~;ea.ses:_

^i':l',

compi~tion

'T'a ie~ :Oe t a il's of,the'i~ sult sare'"r e'ported.':In terpr~ tations'

of"t,h e'"£i'ndi~gs ~·n[t.he"-£unctio~'~of"p.etfOTmance

'fed ,back"

·a;~'discu:S$ed .: ^ImplicatiOns of-thisre searc h,

pa " it icularly .~, pract~ical" c~n~i:der~tio~'

^of

~~cdpackas:

^II,staff-

lII~na~ement'

".stra tegy,

-" '," , ',',- " ',",

advtce. ;To,t-hoc 'a dJlli n istra t i"onarid·st~~f.O·('t'heWat ~rfoTd Hosp i t a l ,:i~par·t.icu) ~r.the staff:'o(1'Iar d Wes t 2A-. To C~rlllel;^{for he-f}su;p~~t'a~dhel~. ^{and to'fri end s.'and.} fami ly who ',gave,me,encour'age 'mentand"inter~st'thr oughou t

.To,Dr.

c,ont i nu ous's up,p ort ,'andespeciallyhis 'pat i encc~' ToMs:

Ca ro lyn-Li ccre,

·~or.

^heras si s tance'wh i 'i=.h

~ontr,ib~t~d

^\

sign ifican tly to \he'succes s ful comp letl11J'l:of'tlie,s tudy.1 TO'Dr s.

'K~zma

^{an dSt o nesfor}

the~r . 'v~~uable· co~ment ; '~;d

J

" .~.

TABLEOF.CO.NTENTS

Page ABSTRACT· • • •

.''ACKNOWt EDGEMENt S

ii Iv'

i ,11 viii LISTOF~FIGURES

p' LIS TOFTABLE', ' .;

: ~:

^{: :':}

I

!ABLE'?FCONTENTS

I1INTRODUCTION

Managemen t of Attendant'.Be hav Lnur.b y Tang i bleR~wards . " , ,',' ,, • Management,of Attendant Behaviou;by PerroreenceFee db a c k"', "

Ma~~g~JI!.entof:AttendantBehaviou;'by. Instructions'.•, • ,• , ,,.'."'~ '" '.',,

' ~~a

^{ement o'·:i},:Atten(,l.an t

'Beh~~iour" ' b'y:

Admlis.~r.at~ve:Changes . ':~ ', :,-'',' . .• .'Con e sions.abo~(:Sta f~ . Man ag ementStrategies,

T~e^Present Inve'stigati.on ..:.,, :: . METHOD •• • •"",: •

Subjects.a~dSetting rueToken EconomyProgram DependentMeasure' ,..: ReHab'n.ity'Che,eks

p~ oc.eduie

^'a'nd

De Sl~n

11 11 13

;.'18 ..~8­ .20 ,'~ 2.

•24 -"

. .

I .

e

,r,

^0.' ."

^{, "}

,' "^'

:

...

.\;" "

RESULTS .•

L :". .

Reliabili t.y

, 1 '

Completionof As signed.Task

I " "

In d ivi dua l.Subj ectData DISCUSS! ON. (.."•. •. ••

REFERENCES ,APPENDI CES

\

"" . "

Page l8

" l8

"

3S

41 l

,l-

^SO'

~\~

.

54

. ·i / ":

:\.) I

,.

. '.LISTOF TABLES

'. . J

TABLE" Pa ge.:

"Re li abili ty-Cbec·ks

Dn~~~·mplet10n

^{,0 £}

As s ign ed.Ta sk.s byAssist an~$ ; . • :29.

Mea~

^{Scores of}

percentag~,Jobs

^{.Comp let l.on} forIndividual Subj ects,in aU,Phas e s.,.

.'

^~

' . l

,. .1.

1-:

,~.

. ~ i .' .

· · 1·

.,

I

r

vii.

'.. j

I I

··.. 1

2.

s.

.4.

38 57 54

36 .ll Page

' .

1. Daily 'Perc enta ge()bser 'Vations Compl e tion' for su b j ect s as a group duri ng,bas el ine, -feedbac k,and.wit~drawalphases•."• •".

D~iiy"Perce ntege Jobs'C'onpletion; for, SUbjec ts asa gro up'dur i n g bas eline • . feedba c k ,andwit h drawalphas es.,• . .• Dliilf iper~en~aie'Olilser va'tton s'"Comp I"e tion '

i~~db:~~~i1~dlwf~~~~~:ld~~~~s~a~~.~i~~:'"

^..

D~'.ily'

^{:,per centa ge}

obser.vati~~s "

Compl et ion' [pri n div.i d u a l sub jectsduri n gbaseline",

£eedback,an~wit h d rawal pha s e s .

"Dd'i y'"pe'~c'e~tage·,obs ervaiion s,co~pieti on"

for 'in divi d u a l subjects during·ba seline.•

.fee d,bad, andwith4rawal phases .

·3.

,

FIGURE NO.

.1

i

L

.. r impoT't8~t^-roteof,'n'onprofe'sslonal ~.tt~ndan:t,^{sta f.f in}i~~ti'-~-': tut_~onsfCl.r the'::'ment'ally!et'a.rd~dand~ent ally'pl''''Firstly,

~hey oftenmak~

.

'up^{. .}~sinu'Ch'^..as--hal^.'....f^'

" o f

anins titutio n"^. ~:enti~e emplo yee populationand-spend more.tillle~i ~ hresi den t sthan any othe_rgroiJp'of pers o nne l

(~'e'nsberg, ' B~r~ett .

^_and

H'~~deT"

^• ."1964; 'I....ata,..Ba i le~,B'rown,Foshee ,an~:A1per~.,1,97 6).'

Secon dly, theinterp er s o nal.be hav Iours of t'hese st affar e,fr e:

.quelltly

_.

'a signifi ca_{" -} nt

' -fa~to~' ,

^{iniri'f luen-tingthe}-beha y i our'

0 ': : _ ',

- - .. " . -',',

insti tu.tio nal re s fdents (Dai.leY',Al1en,~n"sI:.Y.and·.veit~ 1974; Grwenber-g ;:19~7}~ Thirdly,mQst treat mentprograas in' ,i:nsti t utions !:an bere a 4 ily

.illlp'l em'ent'~d" by' attend~nt,'

^staff

't~ ,/g "";'''AYllori

^-and

AZ~in·.-1968·), , ~ p~-a.c~i·ce

"\los t

~'e'asonable

~nd approp~i ate

^;n',man;

s etti:n~'s ~-i~~ethes~ -~taff' ~~O~id~.

di r e ct ,almostcon tin ua l,care and supe rv iSion

to

re·sident~.

", . " .,.- .' .-" '. -' , " .'' ' . '~

Four th ly, institu tionS:_,t!p ica llydonot,ha v e"theresour ce s'

to"e~liJy_ lar~e number~ :of 'pr~fe ssi onal me~;al

^health

:~ork~rs,

and

there f.~re--,Illust re,ly" ~n ' avai1ab~;

^{sta l i-t o}

i,mpleme~

^'a c~~sid'era b le"numb e,r of t'Teatmentp'roce'du res ;-moreov e r, \ t'-is .

. . ' -- ,'.' , '-< "-I " ,,::. .. . . . '

freq u entlycont endedthatat tendan t level s,ta f L canenhance' :prograll'

~ff~ctivenes.s

^_w.!,en

p~aY,inga' -mea~i~gfu~': ' t.~er~p,e~ti~

rol e (~eeEl\ S_wor th and.Ellsworth .

i

- I

·1'

i

[

I.:.

,. -

v,,.',

:,.. .

,.

...

^{,:. ,}

insti t~tio~al'^{resIde nts ,}

,

Indeed. it is.f:a=equ~ntlyth~case in instit utions that .

" . -. :, -.': . . ' " . -:

,-

^{- '.'}

attc!'da nt s spe nd_c ons tderableaaount.s·of timeengaging in ...•~on.j~-b

re lau i

ornon~pro~ra~^reiat.e d·ac·ti.v it·ies:"and·

. - .- . './- .... . .'"

rel at i v ely_lit tleeaeeactually.inter ac tingwith clients

c.re.sid~nts·) o ' i c.rr~ing 'out'~~ Si'D;d prog~a'~'

^dU1:fes.

~UPP~l"1:

.

^.' ~ . -

.. .

- " .-" . ,_\ -.-"

-.

^{..- .}

. forthi~cont c~t!~~h:evi~:nc~din,.~bse".atio~~1 S.tti,d i~S.~Y, ; ..Bensb g r g-;andBnnett(l96 6 ), ~ai1eyet••i. (1974).Hanna.u

(19.7:nI

.~·d !"arr,~n: ,a~d M~~dY ' (U'71 )~ " The.·~.~~5en.<~nv~sy

^{•... ';. .} .' -:~.• rf onisc.,?n.ce~nedwit:~_'Jhem~int.6n~nc eof apPl'~~l'bt. ~,~~a~~1

pel'form anc ~ in theirimpl ementa tion\of the:p reeedure s of,.

'to ken

e~~noIDY :·pr~g~all. ;,/~more ._5P'e~if!~.all·Y

^'.

~ t Ilxa.m~~es.;, ~he

('.

. ,

.J.

·.~

I

I I i !

i

IG i

! I

I

:_d~milra~7 .oy~(:'t i~~/~d' a~e·.rep~,aeed .~itb,. sue~, tni~g:s

^{. ,}

b'o.r~~

domwith routine'anil.;fai'lureof r,esid entstoimprove.

'. " <\--' •.' ' •.

\ .

" . ", ."

. .', ':.".', :"u"~e

^{.o f}

.p erf~rmanc.s te.~dbA:ck ·

^a's'a.Js t r a t cgy..'to,inc r eas e"._

.'_.~

^_,,"

.~nda~ts ' c.;~;·et~,;(

^{vsig nc d}

t~·SkS.-Whic.~ ~onsiste~

^of

' . 'ob"s ervad ons

-

an-d'r"ecordi ngs, " .'of_resi dents ~beh

. .

a viou rs; The de c i sio ri.'to.inv~'s t i,g li te'i n c r e a s ing<ihe.'p r~gTll:mrela te d

,. ' over,'8,one yea r pdT"ittd .'Att e nd an ts'_

pe,forllla~ce: o~" t~e"

~ " '~: ~Pl ~t iOl\ ~f a's'~'ign'~d JSks ' waS;ObS~!Ved '-to 'v~r;in 'an

^{In -}

dete~nlinateman n e r.' P~actical'cons_iderati~ns,Of_co"nd'itiO~5

i~ th~>ri·~ti~.utio~al. s~t.tin~ in~;uen~~d t~e ,se~ec'~ion ~~ . ~ , : .

f:e~backasa.s ta ~fma!1ag~men.tst ra,tegy;. ge nerally,-itis ...

con~~~d~e~~o ~e,,~dnii~istr.at ivelY:a~deC?~lOm.ical1Y^{fea sibl e} fOT the.::progu llIi'nquestibn .·

" . 'As ' Ka'~din "'( I~f3 ; ' ;;7;}

noted •.

both'th~development-;

^{an d}

" _':mai~tenance ... . . Of. ;pjll'~Pria~e\taH ~~T"fOrrnanc~'are

.; '.,' .' '-.' , ^nece'ssary

.

^:;'.

Ifpr~gram'imp lelllentaUon',istob.esccces srut;' Itis·.ofte n

assume'~

.; h a t s'taff'pe;fotinance''i s-ma'i nt il'i Tied

by 'su~h co)l~e .

'( _{:::::::~:: .} :::~:::;< ,::,:.::i.d::::' t::::::':,0:, '::U:::=e:~ . .

a~)umPtl0n.regardingthena tur a l contLngenc a espresentrn an .._.;.A.1 s t lt u tl.On and-the powe r

0 :

suc~~ont.l,..ngencies.ins hapLn g '1' staf f-; L~b.ei,.(1971)'.~ointe d·ouith.3;t·ini hal r.einforcers

! ~_ :.'f~ r :,-~~a.~i ' imPle~~nt,~,ng ))be'havio~r~l, '

^programare'usual ly,:'

~uch

th ing s,'~ s",nov,e~ ty.and.'Pt~~t igEl 'bu.t'these'bee'ornele s s

' ..

. r ·

. \

I \

. ~ , ,

.

fo;~er' fb~s taff'"was'

^'prO'lide d in several.p; ogr ams'( Ayllon

. I. : , , .' .,' '

an d Azrin,.~?68 : "Bu~,l, an dBor,n,':1 ~ 7 7 ; K!_tz, Johnson', and Gelfand, 1972;,Patterson,Grit.fin" al\dPanrar(.119 76;' . 'Pome r l e au, Bobrove,';nd

~ar~:i's,

^1972';'

pomer l'~a~" BOb~ove ,

~n:d s~it'h.

,197.3';"POJllIlle'y.

and.s'tr·~e'db~c,k ;:

^19'74;

~atso~, "'1976 ). ' Fo 'j- "example,

Katz...et,al.'

(i 912)

fOl1nd-'t ha i'llIonedry

, ", -'

,

" ,,~'h~' 'r~,COgniti"~'~

^of,th,:

:~mportance .~~ ,nonprOfe:ssi~~,a ~,:

^,

att en dan tstaffin th et~eatmentof.instit utional,resi den ts

~as.

^{r e su fted}

in:.v'ari~~s·

dnves td gat-Ions

at t~mP:ting ~to

^{.eV;,l uat e}

effecti~e, suc~~ssfuistaff

^m"ana gement

strategie'~. '

^lihUe"

~.nves tiga,tion,so"f.;spec Lff,c strategiest~deternfne their

r~l-atiVe ' irnpac~

^,0n

~taft: beh~'Viou~,are ~eViewed

^{he're, i t .}

shou'[dbe'not ed that sometimesstr atei.J,esor proceduresare usedin c ombinat,i on in various 5ettin~s.' Gene~al1;' ,^the'

fOC~S, :o~' ,~t~di es ',h~s

^{be en-ton}

~~~" ma,~~t~iiance of ,apPTo~ri~te

performanceb~staffwho,impl,e~,entpro,~ram'prote,~ur~s•.

Manage ment'ot Att"endant Behaviour by TanlttJ»e....Rewards ,!One",s t r a t egy th~t)ias'beenaemo~s't,teted,~,s'c on s i~erab~y effe ctiVeis the us e of't ~ng iblerewa r d s', Mo'ney asare

m-

Ano ther'.ere e c t tve reinforcer'has'been'commercial,tr ad i ng

iTig',se~sions.'

de~tiai

child -treatment'i,ilCility "'"

Patterso~

^{et.ai •}

(1~16)

0,' · , : " ,' : " "

fur t he r,dem on st r ~t e dthe effective nessof monet ar yrew ~ rd

when't h ey found thatpayment of nonp ro'fessio nal'a t telld~nt s

" " ' , ,

wit h"smallamountsof money contingentupop. t lieir'tra ining.'

stanps (Bricker,-'Morgan, andGrabowski ,1912;

Hol1and~r

^and

" " , "

, "

.', '

P1ut c hik, 1912;'xc aren a e r , P'l utch Ik,'a nd Horne r ,,1913 ). In

" , ', ', , ' ,,'

profoundlyand,sever e Iy retar dedinsHruti.one Iited restaen es

T'lieoutccne,of a

,s~\J.dr.'bY Pomerl~~u' et' . a1~, :(1913)

sugge stedthat .ca'shai;,.ard,s.ecaid~'sresult'i n,inc~e a se s',i n ,theamount of,apiropri'ate

behavi~ur

inpad'ent's,,Whendie casha....ar-dswer edtsc on t Inuedf~r'thest a f f , Inepprc pr-Iatc patie ntbeha~iour^{increa s ed ;'} Hue1 and...Bo-rn(1911) a,lso,:found that.conU ngent,~?netarybonusesfor staff,tesu'lte'din c~rr~;~ondi'ng'pat~ent'imPt~vement:'

, " ' , ' ' . ,

,pr oduc ed,drama,t i c;i ncrea s es in the',~requency~fdailytra i n;

.

^{" , "}

-

" , '. '

~re s i d ent i9 Y facility fordev el opmentall y"ret ar ded:chlldre n Hr i ck e r,e t.a l. (l 9 72) pr ovfded attendan ts'withvideofeed-

'back:

~'f"

^{thei r}

perf~rman~e ~n'

^thee

'wa!~ ,

^Staff'recef

;'e~ ~~rba1

praiseandt.radin g: stampscontingen t,onth e ir interac t i ng Wj.th'theresiden ts',as'p're"vioUS1Y

:'r~~orded ~n

^videotape,

< Th'~ " '"

'.'

~e'suit

^{'wa s}

, ~ 700\: incr~a,se

ⁱⁿ

' st'aff~r.Sident interact¢on' '\)n

^{, ",}

the,ward,-

a~~

an imp r ovement:in

~ th~" SUitabi~i~yo~' tas~~ei,ect~d .1

J I-

I f

:.L .

i

."because'r emova i',ee_th~'~ ideo ta~efeedb~ek,did.not^{re s u l l in} '.a"los~.of't~rge tb.ehaviou r inc r ea:ses;

rne

sy st ema ti capplication of

a

tradingstamp rein-

.f~rce~e~t , pr~cedtire.,'(Ho~,lander an'd"P1utCh~k

^{,:1972 )'}

incr~a~e'd

att.end~ntper for manc e

o n '

'the c~mplet ionof't:i sk sre l a t e d to

. I ' .i ," \

ca.rryingopt·~.con ti n g e ncy man 1geme ~tpTo.gr.amfo r'hQsp~t"Ql wa rd pa ti e n ts'. AISo."Ho ll and~j. ,et .a L·(19'13)Found that rCinf.ordng

~UEmd~~i~

^{',wit h}

' trrding:\~taIllPs'

^{'ha da pos,H i,ve}

effect ,on thedeg r eetc ¥Ihichpat.ie~tsengaged in,work

ha v f ou r s and tas kcompleti on.

~an'ag~me nt'

^of'

Atteh~ant ,

^{Behaviour"b:y}Performance

Feedbac~'

. ... .. ... . I.

Asecond stTategythathasbeenuse d toincrease,and

"fHlint~in staff~t'l'~ati.e~t ~.ehaVio~rs,isfeedb J !=k(AndTas ik'and

Brown, Willis, an d Reid ,-,197 7;.p.a ~ya n .

71 .

I

I \

1

_j

I

I

I

J

Booz er;"and Mor ri s ;'1970;

.

^{. ' .. ,- .}

1972';"Qu i'lit c'h, 19'75 ; W~'lsCh,Lud:"-ig ;,Rad lke r,"and, Kr ap fl ,"1973 )

~

Es senti a lly , feed b a c"k is

prov·i-tl.in~

^{"i J\for -'}

.' "' . .

ma90n,abo,ut_.per,fo~man~ e ~ 'it canvaryin i t smanner_~.f deliv er y'(wri tteno r oral)-',cont ~nt{staf'fper fora ence , resid en tperformanc e . ccepar Isonamongindivid,ua ls),an d

~ffe.cts" u~on

^{,ta r gete.dper s on s}

,:(sta~f' b~havio'l;lr

^pT

res~~ent

b·eh~viour ). •

'l'here is:~~'id~.nce'th~~^fe edb a C: k ca n'b~'u s ed e ffecti v e l Y

.'" ' . ' " , " ,

Independentof'any oth er'rei nf orc ers' by si m'p1y'gi v i ng st a ff

.

^' ." " ,.

.

^{" " . '}

•he 1p ~~ ill Sto,in st i .t ut i ona1·resi.dentsbut,.f oun.dthat.staff

.. -p erfenmane e gradua llydeteriorated. Afe edbac kip noee dur e,wa s

i~P1em'e~ted in

^{. ,}

'for~ ~f

^a

",~ ·feedba.~k ' She'~'t

^.,It

~hic~ ga~~ . 'in f6r·mat.io'~ ~n '

^the pe ; c ent age'of

t;a,i~i~g '~eS,si o~s attenda~ts condl;lC:t~d

^{o_ut ;}

0;' a~l' po~sib1!,!~'se;s·io,":s .'

^{The:w;e'U'y'd';l iv ery}

andpo;t~ng,ofth~^"feedb'a~k sheets:^{"subs t.ant}LalLy-dn - .crease d'.theperce n t a geof eesatens conduc t ed bythe st af fof

thr~~ ~'alis

(;"a'rd s ) .

pan~an, et. ~-i;'

_.

<:o~~lude~ . '

^{. t'h'at the}

·feed~

^'

back"sy stemLs.cn e-econcatcei lIIet hodwher-eb ytheper-f ormanc e

ofatt,~ndl!lni.s'can belIa'in,tai ~ edi,n't,he'e bs enc e-c f dailysup~-B.·

vision.' A1so, Wels chet~a 1 ".(1 97 3 )use d-pe ;for manc efeedback'

~" '.-.',', .. . : , " \

'to increa sethe dail ypr oject act i v i ty of'st a ff

.in

^{a-st.at e}

,

^,'"

.\ .

. -

result s

in·._t~~" '~eha';i;ur ~odi£i'c:a'~ion :p~~gr-a~~

^{::we'r e'}

:~ost~'d"

,:,., ' " ,", . ,

..

, '."

. .

.' ... ..,",'.

,~~.relnfOrCem~n.t:t.'.~ a_co~pat~,s~n- ~edormance f.e.edback .~.:

memos ofinstruct~nsto,,s t a f f,and wor:lcsh op teach i n g , he:"

£ouddtha t the

llI~mo~

^and

wor~shop

^{wer e}

ineffec~i~~ ~[if£~

~ana~cment

pr oce dur e s.. ;

' ~n ~'~5tit~~i~~ ' foi-" :~he ~~en~ali'y

!

in the'war d ha-qway·.

. " ,- , " , "- - : . : ,

. r-eta rded,whileth~ perfo~.. ahcefeedback ,(togeth~rwit h:'staff.

sc'~edu1ing) 'effect~vel): m~tiv~~ed

;'.'. ,

...

~ .

~he s~aff,

' ^to'i'cad,.

d~iiy '"

~ec reational.

act:i'.;-i

des'

w±

thth e'r~ s idents Quit itch'

con~lu~ed', th'~i'perf~rmance fee d~ack .~~ ~':usef·ui. : ~t-aff.mana·ge'

^•. B1~mt·~ioce·dure'~e-adilY~v'a i i~ble,^in.~n~tit~tions ,

" . ' "

Manage ment·of Attendan t.Bel-iaviour',by'Ins tructions A third strategy.tha t has beeninvesti-gatelj.tsIi.,form ..

~f inst~uct'~O~~'I ~ech~ique,

^{I n}

relati~n

^to

~he'~~intena~ce "

( \ '.

-

"o fapp,ro,priate ~:ta'ff~~haviOu~,^such·proe~dure(~.,~Su~llYin.~^.

vc a v e situ ati ons whe r esta f f are Insor uc'tedrc.be bav eina,

~artlc~l~'r 'wa~ with" client~

^or Tesident s':(Rue'I 'andBorn ,•

t:

. ....

.

.

.

- td dev el op skill~·(i.'~..US~.QfpLann ed jecturesj, 111 theKatzetcaL, (19i ;z)studybaselineobservations

, . .

da ilyrecreation~l^{ac ti Vi:.ies'for i}n'sti t htion al'reside !':s wa s'ineffec t ual.· 'B.tie l"an~-Bor 'n'.(1 97,7 )''pT'ov ided f~r th~r

long-t e r m changes ilj.'st aff,behavi our.

,Mode lin g

soc~~ i

pr a Lse

(Chris~ian , H.C!l1omim.~nd

Lanie'r,:.i9 7.3':i

M~nt-egar ,.j R

^ra,

~id"" ' ''d ^{E W ' 1l . 1 ;9}

^{7. "}

S tOff'i.~y" .: L i~d,~y .

a~~ Tayl~r 19:9) ,.-and."wd~lin,g.(Wa~la:Ce" D~Vi s...~iber~an , an d Baker, 19 73 )have.eisc ..been used,assta ff management

. . .' '.

strateg Les, Fo r-example},Chrhi t i a n et..eL,".(19~3)-de sLgned a:1.'progr'am to

t'e~-Ch':28 s'~ver~IY a~d pr~£Olin-dly/retarded-,f~male"

pat i e nts

t o '

ea t witha...spoon, Th e'intention ""a\ thatth e.

.

,

! ^y

. l-

10..-'

.

.program·wouldbe mai~tainedb! the at tendan t ward staff and WQu I d rc.sul-i'in-decreased,involvement"by psychology

"d e p a r t me n t pej-scnnei.".;The-tran~i ti~I)-"t08staff -run program

was -f~c'ilits t e dbyre gu l a r.m~et ing s ~;a n d -pra i'sc "and'so~ial

rein~orcement ~e~e

^{given'to:th e}

~tt:n~i~nt; Whene~er - a;p':ropriilt.~~

^.

Th e.resu l t ~were th a t inappt:opri~t~eat Ingrc s pl;lDSCS of t'he '

patie ntswere s i.Bri~ £i cantl y.d e c r ea s ed; thenu~b:erofpsycho logy personnel,i mPle ment'i ngtheprogtam-"',a,s"ied~ced't o; zero'fl'o~ "

1'0, - and.t.he

n limb'er of

atte~dant^staffincreased fromz;ro'-to';"

f01;1r.pCI'me~l_over,:thcaurationof:th,e

study;._

(~s:,~a~s':re'i'orteo1~. S'tcffeIma yrve'tsaL, (1979) used a pr-ocedur-econsistingof telephone

:remind~rs ahd,,~ontingent'

_{. ' .} '

~rais'~

^to':.

i~~rea~e ~:hi

,

: ta ff ' sbe~aviotir,Of,hold~ng tr e~t~i.m ts e s s tonswith lon g;

$l'ayschfzoptrr en Ic'p a t i~n t s'; ^{Th ey}con~luded t~at·the int er- v~ntionof promp.ts"an d',s:O'Ci a lre inforce~~nt:"wa s, an'~ffec'tive ,means of motivatingsta:ff ,'trea'iJiJentactiVit~es.'

. In.t.h_c

Wa'll~~e '~t. al

^-.(191,3)

· ~tudY' t~e ·pu~p~s'~.'~as/

^to'.'

. .increase-vard staffIsatt endance at,a"social interactipnhour

~~ld dai~y

^for'

p.atient~, a~~ , sta~f. '~e ith~r instruc tii~~

^to

'at,tend,n~rensur- I ng,th a t therew~no'c omp e t i n g du:ties.aff.ecte d staffbeh a yf cu r-~ Ho~eve r•.whe n'profession.ilstaff,such'as

.,' .'. '

.

^{,'" . .}

th ep~ychCJlogist'OTnur~in g"sup erv d se r a:,~ten.dedthe,s e5 s ions~

b'othstaff,andpatienta~~endan~ewe i e.increased.

L

-v.

J _{. J}

11

Managemenlof

Atte~da~t

^BehaviOurbyAdm:nl.StratlveChanges

I ·· ... ... . .. . . . . . .

rt,,holl l,d benote d briefly tha t the r e isan o t her form of,

stafr-~.~T;agem~n~

^strategy,

W~iCh i~, p·erh~.PS ',';~ita bl;

^.,

termed 'admi nistr ativechanges"in a ward'or.In stf'tutIcn,

Suoh:.administraUvemanipulati<mshave'rang ed,f r om simply

disPla~i~g ~ p~5ter-

^of

a~ ina(p~ro,,;ia te ';taff'~'~haViour

I" . - ," •

'and admini'strativepolicy changes~f-two,^{different'kinds} each , in addition to three'for ms

of

inf or mationfe~back

<Andr3Sik and McNaJ!ls :ra,·,,19'77 )

~

^{' Bot h'of}

th~se:,ihvestiga~.ions

re5ul t~'dhi"i mp r oveme n t s

in

appropria testaff~erfoT~ance.

As we1I1'

~n~ed:'

.^{and Bible}'-

(.i'97~)

.' ^obta,i'ned...

imPT~vement's

. ⁱⁿ

s~aH

performanceby imp,lementing'vduty-ca rd s "~or.attendant.s in.eninstitu t iO~forse.verely and pr.ofound lyretarded,adu l ts;

~his admi~i.strative p~ocedilre.' emPhasi~.e~ .

specific.ityof',jcb-, des crfp'tIo n s ; 'assignmeilt s che dufesjrandInddvI d u aI re- spopsibilit'Y,forjobcoinp lelion'. fi',.

C~~ci~~'ibns

about Staff-Management'_.

Strategi~s

_.

.

~h ereview of.t beliter a t ur e onstrateg iesand'proc edur e s to.mai ntail).'.a~prop~iatesea,fibehavdcur.i nth e.i ~imp l eme nta ~i 9 n'

of"

trea~men.t 'pr~griI~s^shews.~ons.iSten~l{po s i tl vt;.:! e SUl ts with theuse of. tan gibl e re infor cer s'[HcLLan derand Pl utchi k,'

l~i z ; Katt .et~ ·~l. " 1~7Z ': P;t t'lil/s~n 'eL a l~ . i~7,6) . 'Al~o .

^;

thereare

, indi~at ions that suchan' ~pproac~ le;'~s

^{to ccr}re s p e nd- ingapp" pTi.t ' Chan"} T " 'd"'" b,hav',u" (Bu"1 andBOTn>·

-'.-...;.."

12

I

\

. \ \.. ,

^{, '}..

1917: Holla~der.et, a l .., 1973 ;.Pomerleau:at.a L~.1973). The;"e:

i~ :

^{eVidcnde to}

~up~~r't

^the

us~

^o'£,pcrfcmnancefeed -.

b;Ck" In

'ff,'c~ive

pr-ocedur-eto maintain Haffbcbavlou;

~ .' .' .I ' , . ' , ,

.{panyanetva L,",~97 0 ; Quilitch.197 5 ; WelSchet.aL',1913 )i

~lthough^'ther_e'have bee n suggestions thatbyits e lf--.the·

Utilizat i 0i'!'of fe'edbac.k

~ay

^beiillited (Pomet l e au

ct- .aL.-

19'13j"

':~om~er .a ,nJ ·Streedbe~k

^{•.1914) H is}

~ppare~t

^{.t ha t 'in-}

," . . I ,.,'" : , . " , ,' .., '

structionsal one,havenotresulted in-suc c e s sf ulmaintenance

. - f '- -,' -. "

of st~f;performar~e^{(Bue l.,and}~~rn._^{:197?;. _}Katz

e fal:..

^1972;

QuiIdtch,1975). and arepro ba blybetter.usedin

c~mb ination wit.h·O~h~T.:.st:r~~e~i~~. ·

^There

i~evidehce

t'hat so cialpraise or appr oval is'an' fectiveprocedure (Chris,dan,et.d:,197.3;

St~ffelma'yr, .a1 .• 1979) ..and'there.a re suggestiri~s"thnt

•.

m~deling

^'rna,

impro~e,jn~tit~tional-

^{:1:a £,£}

b'eh~Vi:~ur ;/Wa:i1,~ce

^"

et:al.'; 1973). Fi!1a'l1Y"'adni~nist~ative~anip·ulatiqns.of

~'rogram, 'pr~ced~r~~

^{:'orpo1 icy:}

~a'v,e

^been'

d~mo'~s'trate~

^as:'an

effec'tiv"e" 's~aff mima'gemen~ stiat~~y'

(sne'ed and-Bibi e ,

.'1'~79) .

: "

^.

.

^"

.

'1t is:~li s ti~c~ ~yClea.:r·that·ma'na'gementsttategi~sare

;necessa ryfor the' long- t e rm

ma'intenanc~

_•of at tenda_{-, . . •}nt_I staff_- , ,_.\ behaviour in ins~it~tionalset tIngs (seekaadfn,197.:;chapter;. si~). 'HOWe Ver,' the~dectionof a,part icuia'r,str a t e gyi~

o,f~en

^dic t a t e dby'pr a c tic al

:cons ider~tion'~ ' of:'con~ition~.

ⁱⁿ

the ins t itut i on. TQ.,er e f or e',-the use,.of-themost·effective .app: oach'('i . e .

Tein'ro'rc~rs .con'tinge~t

^on,s1:'aff

b~ h~~:i~U~)

^is

,·,n.~t,~lwaYS,pos siti le (And~asik an~McNamara,197~;, B~,o:iin' etca L.,'1977 ;"'Reppuc c ~ a~~Salmdc'rs..1974). Po t~n tial

..

.The Present Investigation

.r tiepre~·~n.~~tudiwill,investiga tethe"~fieC:tiv'eness" cif two kinds'

~f,

^{fe.iJ'iiba'ck}

~n

the

'p'erforman~e

.of

'nonprofe's'~i onal

." ."

.

^{, ,' .}

attendant sin,their'~imp lementa t ion-of-th ept'bced ur-es'of a

, t'o~~n econOmY '-~TOg~am> ~he -f~r~'~ ki~d ~s" 'dai1y:writ:ten

^feed·

'ba ck of,

s~aff p~erformance , . ~nd .

'.t h"esecond

i ~'

^{da i l y.}

wri~ten "

feedback of rcs,i dentpel'form!!- nce.

I;, . " ' " '' . . '

\_:Th_~.:rg ~_~m _h~Sbe~n estab~ished.fO~ sav.er.aI .years-o,n

a'long-termwa r dofan.I nst ItutLcn(h os p 1t a I )"for-the mCJ?,tall y

retardedarid'

~entally

^{il l.'}

There ar~ app·To~im~telY450 ·res--··

identsln t heinsti~u'tion,:"hich:i~c omprisedof12 wards ; over 350 of'thesercs1dents.are'cons i dere'd to be long .term .or"~chron i~J'·"·and's ltuat~d onni neof~t hewar ds.:The'fOken

e~ono~y

^{-prcgra a}:a pPI'i e sto':"an" averageof 24,ma le

.r~~id'en:ts

Jo £

^{ewar d}cO~mOnlykn~~in-'tl'Je ·hospit al.as,.the.'behaviour

L

,.

~OdificatiO n

unit. '

,~and ida tes

for tbe.umt

~"~ fr~1I ~t~eT

' ..long ""te rmvard~ . andare"adtlitt e dto'~heprograll foll owi ;g

p ., '" , . . -' .

_.-behav i oura l assessment and whene vet".a bedis aadeavaila ble

.'2;;5" - .-". ", .

due to:a discharge or transfer-,

Therea son'for the-es vbli shment' of the

p ro gram

^was

the..nu.er~us^{ha s pi}t~lreside~tsdet.er-af n ed.~o^'be.£undti on -

ing··-~t. ~

^low

, ~e'V~l.· ~na. numbe; '~f .beha~iou1'81. ~'kil1 S ;-

^:The

pro g ram' sg~n~'ral,a,~mis-to',ena bi e as.many'.'! esidel)ts

a s

poss ibl ;tof~nction^{mo! e,Independe nt}Iyand"rely.re s s.onstaff','.

I tis.also

an;iciPa'te~ th~t :residents\.~h~

^.

b~;

^{'be tter'pre pared}

~or

^possible

diSchar8eint~ " the comlllunity~,·:·

^{Thus•.t.he pro-}

.grani

specifie~llY emPh~she~'-'the de vel0~Il~nt' o f se1f-,~a're';~

....ork".andsocia l'ski.,Us.an~al s o is.direcfed.at the, Ilodific a t ionof maladaP t.heorfr~ble.,b~havi~;Jrs•

. .'".'Crite ria

' f~r

" "

target _~behav~~urs .~re oper~U(Jnall /Y

^{.. ·}

, '.defi ned":'a!1dre si de!1u .are~~ardedtok e~s....hen e ve( they. '.

satisfy'all

of

a'urget'",scr'i te~ja':."T.h~'re

is

^a"l ar ge.assor t;.

~erit·.o~b~c"k:~prein'for~ers'^{.av aila ble}f~~·~xch.ange^.:.}.tten -. ·. da.n ts arerequire d·.toobserV~.~heresident'sonthe'cr ite r i a for ea c h of'the targ et be he v f cur s, re"c or dth~resuit~_of,the

. )

.

- , '.

.

. ;.~-~-",-.~.~ . '.. ~'::::;;~~*f$i"~~"; ,,~~:

.:

'1.-t.

L

.' I·

l

. behaviours.

AsInd dcatedeer rter, the.rncenetve~orthepre sen~

resear chresultedf~omiflfor ma.lobservati~nsd~Ting'a orie yea r period which'had..reve:tl edthat a~ tendan.t s^I performanc e

• j , " ,' ' " " ">:. -.',

on:the. completionof assignedprogram. ta sks varied in an

i~deteTminate,^{man'ner .} Ba"~eao~th~se"obs'ervations^{i twas'}

dec~ded '~o' in~estig~/tC\- '~yitemat ic 'pro~'edure s

^'f0t:incre.asi ng J

.

~n~ :maint~ i~i~g

^'th:

pi~~!a~, rel~~ed "b eh~v~oUTS.

^{of the}

.atte.nd~n~s•.''f.hedep~n~~~t,v~riabl~ in'~the,p re sent'inve sti-

'i~ tion~ w~s ~ta£f_~~~e~i.o~ o(~)lsikned ,ta~ks',

^e.s

d~termin,~d

by'the iT"re'c rGns s of

~bservation~

^{,on th: desLgna ted}

,fo~s

fcir

th~ ta·fg;i)beh~viou~S .

The tise'

Jt·

dat aon'therec ord '

•' r, '" " ," " '" '..' ,' ~, , .

for ms'as:the aeasur-eraenticftaste'complet ion was'ser ec ted

· " " ,' ' " . ': .' "; ,"

;becaus e.~tisan,On g~ i ns."pr.~cedur,e,in'~?e:token'ec,~,noniyproJ gram.andre adily a'vaUablePor,comput ati~~and ana l ysi s';:'..

" , ' ,

.

Also;'peTiodi~''!'~liability ~h'ecks,:;~,v~aied^{tha.'t·dataV,r es ent·}

e~

^{onthefo'TJlIS}

o\lccUr'!\t~lY .r·epies'e~t~d '

the tomplet i on'Qf

~,~,,;>e~vatio~s

^•.the,

.recor~in.g, Of,

^the

~e sul

^{ts ,and},aj,'ar d :Lngof

't okensto'thOe

, res id~ts 'mee~in'g

c·ri te ria."

I , ' ': , " ," ", '. .

Unf or tu nat Iymanypotentiall yeffectivereinf or cerS wete de enied no feas ible'foruse in the'par.t i culari~s ti-.

·

. ,

" ,

.

tut'i O'hal,'Stlt -t'gin.~uestiO~'due.to an:umb~r,of,fac tor s~';

Such-

fact~r

^'

in~l~d~d

1a<:::1 ofdi r ect

coi\tro~./Qvei'

^.r'einf orccr.s

~ation~"lIith,reg~:rdtoi;ossi bl e'c ~n't:tIigenc;ies. However",

'it,lias.epparene'that.vari ous.kiiidsof'~er form~ncefeedba"c1c

I

·· [i .·• • I'}

:~.j ;I .

y 1·

,

were .pr actIcaI',';'and'c ert a inl y·f es s ibi e . to.inve s t i gate,'a s- ,a

s tr~tegy

^to

~i~~~ain_'

^{th e'pr ogr am}

;~'lat_~~

:behav·i.our s

. ~'f

^.

attendarrts, r:~ ,

As previouslymen t'ioned;,'two k i no.,s of'per fo'rmanc ~'-'.

f eedback. .

,~

inv.;ti,".d in

to .

pm . "

,,"dy.' _I;"il~

the. mode,:

_~f

^..

del ~very

^'wds

th~ :'~anie' i~' 'bQ~h ,

^the.

cont~~t"~(~~h~

;eedback

.;,a·rie~"

^The"

fir~'~ invol~ed da~i1y "."r·itJe~ fe~dbac~ '

or"s,taf.f'c~mpletionscores_,"o~,^{assignedtasks,}~hich ~eTe

p~sted'

ⁱⁿa COn'SPiClUJUS"locktiono n'thewardi the

~econd

f«db",_{:_" , _}

~ond

_,

ltion con.",.~

_{, ',' _: or,'}^of_-.,^{·dail Y}_{_'} ^{. .it:'.n·}_{, : " .'}^{(;nd pos}_{:_. "}^ted)_,:,-.

feedbac kfor',st affof residen ts'~perfonna.nce'SCOt~S,0." the program~starget behavi'ou'rs•..'Theadm~"iiist~ationof the'ieed~'

ba~k co~-t1ngenc~e~' i~'

^'the

'~~r~se~i

ⁱnvestiga frori

-entail~d" a

. ' - ,, , ' !

,:"w~thdraw81e:icpe:iJllen~il:ldesign(Her-senan~.-Barlow,.1~76';;.

.L:itenberg',1973r_~ n,whi c hb~ se li neC,A),a~dth etw~,-fe"e'dbad conditjons:(B

,~nd

^{C)we r e}

'pre~ented

^'in-ani\

~B

^{A B'A:C,A C':A}

sequenC:~.,

^-

ThUS '-!!.tt~~~~n~~

^".

comple~ion ,'~'f

^tasks

,'were. mon~~or~d

^.

thrOugh~utaii phas e s o'f-thes~UdY,'to'~eterm.irie·the·'effect;.~·

oJ'the.fe .edback

.co~dit.ions

^{,bei ng}

app~ i,ed :

^.•

At"ongwith,theaf o-rement i onedne ce eear v ccns Ide rat.Icn of'prac t i c'~lcirc'um's't 'anc es,'in th~-i~stitudon the r e-'-wa s.

•" ', ..'r

e~idence t~_,supp~rt",t h eus_eo£w;ritten .feedbackp~~c~~~:es as'an effective staffmana ge:m:nl.:strategy (And -rasik:and McNamara, 1971;,Panr an et.al.. 1970, Q~iiJ.tch, 1975 ;

,

,WelSch- ' et . al:,'".19.7,3~.: , Th~ p,r~~~~t inv'eS~igatio.n · U5:ed

^{__';», .}

·,'.pri nc"iple ssome"ha~similar to',thePanyan 'et. al.'(1970) and

•. • :,9;.,... .- . . i

r:

",

r " - ""

"

\ "

.We'1s~n>~'t. al..(19?'3J.studie s'in that·; tt.ellp ts·we n·.~de.t q

.~iap~~~ve dal~Y 'pro~:ra •.· CO.P~~ ~iO!1. Tes~l

^u

_Of~ 5.~.a:f

^by

-p~,~ting· ..

wr{tteacOllpletionsc ores. Anext.e nsio n of.the-a bove'fe e d -

". "

ba~k ~tudiU

^,vas'

'the-'~xa~tn~'ii~n'

^of

~i~e erfec~s ~f ~:ri

^/ten

-.fe~~backof':;eddent~'-.perfo~~nce.

The'pri mar y ccnc ernof"thej:;:"e s e'p.t;study.is:aPTa'died .

V" ' . " ":, . ', "' -.: '. ,' . •

one.-to'i nv estigate theuse-of per fol1u ncefeedba c kas a

l!I~th'oLt'o'

^{Inc rea se'}

~nd ~~i'nt~in' attendantl~ . · CO~Pl et ion

^{of'.: ::}

:,", - , '

. --

^{'-,', "" ~' ; "}

,.,ssigned.tq s~sin t~etoken•.e,c~~Omy~pr b g ram. Ap p r ? ~ r j. a te :~~rforma~cei~ carry~ng_.out the'tas~s"lias,C~~~ i de;red.,;

nece s sar afor the su ccess of the -progr 8}R inltSattemp ts ~:

,ee

i~~~ve resident~ '

^{lev e'i"vffu nction in g}"en

' ~ehaViOl:lr al

^.

sk p ls....,Also, t~h,ilDpTove~eritha d'toOCCUT.with i nth e exist ingadminis tra tive-, ec cno..tc ,andpoiiti':al cond it io ns. . of:

the.ward :a~~· ho sPi'tal.

^{I't',wa s'}

a~ti~ip.t,~d

that fe edback . "

~:-O~'ld,^{be dea}on.stra ted'as an eco~o~i~~l:^{andread ily}~~ail~~le^. str a~e.gywhere by,the~ppr,opr ia t epeTforllanc~ofat.t~nda-n ts can be .d nt a i n edininstituti on sthat~elyons~ch d iTect

c~~~<5ta~f.te:illlp"lell en t'tT"eat.en~·p.r-e5'd ures_

Sp~ifically

^{'it was} hr£o t he s h edthat::

-.i . _{· writ·te~, p~s~ed}

fe e d ba c1c

,~~ ~ ~tend~~t sta'~~~.rer~

^:

.f o r ma nc:e, (coIllP.le ti?n of ass i gn e dta!l ~.s) int.hei~impleme n-

,ta t ion of'atokeneco~omyprqgram'spro c edure s"i ncr ea ses the'

co..phtiO~

'rat. e

oftasksby'staff_'.

. "'

' .

.

.

^{. ~}

. .

^'

....

.. . .- ... ..

t "

_-,

)

I

.II "

i ")

!

. .' - .' - ,-' " ".

'res i den ts'intheprog-raJII, as'

a

re sult of asmajI number of' "

. , , . ' - -- ' .

attend~~-

^hr.'allJ ,s ta ff on:dtity'.':. •

Approxi~ately"

- . • ,- -

/1alf

-^of. ^'the-.

ineetin,~time-in cludedcons i~et;ati~n,,~fva rious'.a~pec ts.Of.th,e

)rinci'Pl~S 't~hvOIVed in th~" imp{ementa"tiori-,~f , c~~t'i~s'~'~e/~,

^.

m~ti;ge'~~nt , progr~ms "

As .weil .·'ther e

wer:~ _w~eidY,

^{wa r d}

meeti~g.s

'Tt;'; work's c:h"edu l e

~~nsist'ed

^of

a~hift-' rotati~n_Qf;d~yS "

. (~,~'OO ^{- .} 16~Ohrs'. )

^"

~ven'i~g~Jl600

^{- 240.0}

' hr~~

^L,

a~dni~hts

(2400 - 0800 hrs.) ;.twoAss i stant sw~rked on).y~da;'~hift~' wh ile: lZ.',rotate,d.

alP.~ng--

^the

,t~~ee' S.hi~t's"

^The

'~~hedule

^{wa s} ar-r-angedin four seve n-day. (on ewe ek ).blocks so.tha t.an

·· A~s istan.t

wou l dwor k

fi~e , nigh_~;

of

th~ .£irst wee~ ,five ,'eve~ ~ '

"Ings of.thenex t , then-ablockof'five days ;andffna lly,-.a,

..'r e li e fwe ek'whieh,'u s ua lly incl uded tw-o ni gb t s .-.two evenings, .

'a~d

^one

da~. T~~ -'shifts wo~ked

^tn'_a'one

w~'ek 'bl~ck

^{'cou ld'be'}

~_~ve 'conS~CtitiVl; '"

^{thr ee}

shi~'t;' ~ith

^two

o'f~' a~d-

^then

• , . .J.'

or:two shift s wor ked with twoof f andthr-ee-on,

'One'sUb jeet resignedhis'po siti onInthe'hosp i talfive.

we,~'ks int~ . th'e:

^{study ,}'^and. '^{'asec ond:reSign ed}'.^just.

befo"~.

~~^'t.he'

'comp,leti O~of'the~i,X'thwe ek.

I " .

.~

Thez:ew~re,39 ma,le resi de n tson.'thewa-r~,.an d ,whiletjie _ ,

numb~r, .

va;ied'

~hrOugh~ut

,the pre sent';s'tudy ; an'aver a ge

o~-fz}""'" ~ .­

".~'ere-ⁱncl'"udedin'the:to!.~11: ec~nomy.^{progra m.} T~e^{numbe'r .}

ranged,fr om22 to_~6 ,'andth erewas';atota l

of

³¹differ en t

\

Of.the.study ..,Th e "pr i . ary"dia ~no ses

/ f

^the'p ro,gr~lII-r e s tdents, asi~.dfcaied:orr-t~ei!cha'r~s,bY' ,t he'att end i ng ps y chiatri'st,

mental reta rda t ion,17;,5chhophr:~nia .10;"-and

-. .' " ' ,'

.

': -,, ' , ' " /'

'b.~hav ioura~problems.~,4,...Th~.irme a ':!w~ S'3~:!\, yea rs~with.~, rangeof'18to;53 ,years., Th~.length'of,'.t i~e of'continuou~

bc spd talhation'since'la s tadmis s i on'-rangedfro'lII,0.9'ye ars

to ,

'22 ,8:years'w,ith:a'mean~~f,5.9,years. ,Th,eTok enEco nomyProgr am

'" ..,, ', " , ... ^{, , ,' "}

,.

't ha t posit.Lo ntEc r three years,'excep t for a pe'rLcdvof approxf- mate Lysi~month~wher'..the"pr~gra!!,'was inteTru p t edbecause'o f

"a~trike_by .nonpr-ofes s Iona I startin'the hoapital. "I'hroughout

the'pa s tthree years various.re vision san d adjustments'were

m~d~

tel'theprogram,

wi ~h'

th e','mo s t recentoccu rri ng

t~o '~o~th~

· .

.'

bc.fore thccom.cncc~cntof'theprese nt·i~vestigatioI\.

THe'.targets of the t.c ke neconomy",pro gram In cIud ed eati~g:.drink ing-~eha'1liours.per-so naj,h,;'gi~nesk.li lS,r-c ca soc ial.In te'rectIcn.. recre at ional'aativitIe s ;andwOrk,per -

~orinanc£..,:'S~~-cific crfteri'~ h~dbee-n,de'vei.oP~d for'^{thes e} targ e t,behav~our s,andtokenswer e;"a wilTd ed to·res.iden tswh-~n /

r .

I

i·'

I

1

- . .1

JobS. .-R~om, ^Care,a~'0830 hr s .

. l ; " ,

Job,l ,- Eating' an'dD~'inkiQg,at0800hr s,

. , .

,J ob'8-,Rec r e a tio na l,Ac tivi ty Sur;cy,'at170 0 hr-s

;cib. '~

^-

'Recrea:i~nal " Act'i'vity' ~~r~e;. '

^at

203~ h~s. ·

T,here'wet:-eihdividual record forms for,each job category',

The ~Titer'i~

^for''the ;esident

target ~ehaYiO~r SWere' ~is~'ed '

on"

th'~

^{fo rras}_,

~'~d ther~-'

ver e spaces in,wh i c h'to,

r~cord

^{the"re -.}

,.' .' ,.".

su fes,ofi'the obser.vations .Eorall residents (AppendixA).'

the,a s si gnme~t',~fsta~i^{to,j o b}ca t e go r i e s wasdon~, .~y · the'senior Nursing Assistant; at the end,of each'da yvhe: • assignedstaff,forthe next day byfilling:inthe Lrtnaees on the-

'J~b Sc'~edule F~TIlI "

CAppen'dix'n)'

~~ich ·was .posted·

^on'the

reC~T'd Ith~ r~'sult~

of'" the'

obs~~v~Uons

^orithe

:"appr o,pr i a t';desi'g~a~ed,forms;.lnfo.rmeach resident'6f performanc e,and award tckcnsito those meeting the c r Lt.er'Iu (e xcept'f,pr

recrea'H~~at'- ac·t i~ i

^{ties for.whlch}

"there~

^were:no

.

t~'ke.~s ' a~'ard~·d? ;. " The: lli~e

^{:'j O,b.}

~at~~'or~e~,

^{,a nd,.th e i :.}

,:~Ch~dtil~d

time sundercons id er.at ionin.'thepresent,study, wereas follows:

~.h~,appropriate.~orm 'frolll~'the,f,i.l ~ngbox(~ituated in the /. nursing'station)'a~the..scheduie.dtitne,'"andcOlllpletethe set

.of cbservaticns'and recordings.

; . ', ,' ,' , '" .

As an-Ll Iustrat.Lont NursingAssistantL.S.,·whohas

'. " ' ," "

d:iriing area with the ~ppropria~~"fom , observeeac~.re'sident fOr the "eatIng"and ,drinking' criteria, record the.r.e su lts.

.

^'

onthe-Ec r m, Lnformieachrre s tderrt of hiscpe r fornance, and award at~kentotho s ene eting.rhe ciiteria jlcr the purposes

of the 'p~esent

'i nve s t i g; t i on .

,~. S . haVi~g 'ObServed

^each

;e'~ide~t

^and

~ompi~tedthe

^{rec or d'form WO'uld ha've'-sat i ;fied:}

t~e

.c r.i t e r i on.f l?r

~o'mP ket i~n ~f

^an

.~ss ig~ed , t~sk.

The coapje ted record formswere'filed in' the nursing

s't~tion'fo;

_. ^{<theday,'an'd}

,c'~ll~ct~d" the>;'next n;~rning 'bY

^{'t he}

'

. . '

ProgramCe-ur d Inator cwhctook them to'hi s~office'for ceapu-

~a t ion.,and·an a~ys i s . Th,esecollected'forms woul d contain

!h ere s u lt s ofob serv~ ti onsfor the'previo us'day.

.'Dependent.Mea su r e

The

d'epe~'de~t

^{mea sur ewas}.t h e dally

p~n:eritage

^of

. ' ,"

":"~s signed^tasks':(j~b c~tegor-ie~J'COIllPI~ted.^'Th;!::'lletermi nation

of cO,mpleti?n ",:a sbas ed.enAs.sista nt's'

recor~~gs

^{(dat a ) -,-,}

'<,

onihc'jQbc~teg~~y'^fo';in.s. Two completion,per c enta ge,scores

.vere-detemtned . .' i

1.

" . !

."

.

^{", '}

. : \ \ '

^.

First,the perce.ntage,ofobserva tions'colllpleted,'onall .

i~divid~al ~es~dents f~r ~ll .jo~ cate gorie~

^was

c~.m~u~ed d~il~

by'di vid i ng. .the.:tota ln~berof observation s.'recorded <as,

.

'i nd ic a t e d by't h e.d at a on the forlllS)by.thetotal-number of

.

.

^."

-

obser va tionspossible0-":Th e Prog r a m, Co~ or dina tor.,cal cu l a ted thissco,re

.

'~'Ilme~ iite~y.fo11^. ow:i ng the collectionof^.th e,r.ecord . ',f o rmseac hmorn ingo Thenuraber ofp0 1Js i b l eobserv a t ~o ns

var i ed frcmdayt~da~,becauseof'phy s i c a,lly illresid~ts , day leave. ~emporary,tr an s f e r.,or'resIden t attendance'at aFti v:it i eso f r'thewa~d. .(Th isfirs{,s c ore°i sthe "per-c ent>

·~geObservat io ns Completi o nf,). .: .

Seco~d,^{·the, p e r}ce nt.ag e.9f'jcbYcat egurLe sorset s of

ob s erv a ~ i~nscompletedw~sccapu ted, Ag ain thi~infor~ati o":. ·

~~sdeter. ined,frl?lIIth~.record~forll s.co llec t.edby th eProg ra m- ..Co--~t:di na.-tor.. It',wa sca l cul ate dbYd i ~.iding the nU7ber

of .

forllls (both. partiallyand fu llyrecorded)

.

bythe

.

t.ou l numb~rof job·c ate gor ies·po s s ib leforthe cl;ay . Th'enuaber of' possible'jobca eegert e s varied'occasionall ybecauseof all

·res i dentson'

-excurs:ion~

^{ou tsi d e}

~he.

ho s p i tal ,'or requ i rem en ts .of

~t.~ff

^fo,:

e~ traordinary'

rea s o n s,elsewhere⁰

(rh~ ~

^{secon d}

·

s~ore

^is

t.h~ 'Percenta~e '

^Jobs'

COJlPle~ i~'~, )'o

^'.For'th e pur p o s e

. ','. ' .. f ,: . . ' ","

ofillustrati ng the:se c ondscore: i feight.ofnine'schedu led

~obcat~~or'ies,"'Were complete~ ~i'oe.:r' e cords ofresi'dent'o:b~

servationS~~de- o~\

^{thef.orms ):the n}

~~e completi~~ r,a~e.

^{wo u·ld·}

..be88.9" ',,~

<

""1

\ I

\

I

.or time fromother dut i e s .

" ' " " '; '.

cc- ordm ator. .The ywe ~e ~c.hedtile d,rand oml y on,.awe ek ly

.ba si s. a~dth enumber p'er,~eek'depende d',ontheavailabH~ty:

criteriawere th a t heor she was .Ln the vicinityof theresi- d'ents_~oobse rvethel11individually \andthatth~,.res~Itwas'

~ecotded o~the appropri~te"f o'Tlli.,att,~etime,of"theab set.

The r': l'iabi.lit;

of 'ustngdat~'on

^the lobe-ategor).

'~e -

corl!.,fo r ms35 the

llte~'~'ur'~ment

^of-'

ta ~-k'

comple'tio'n'

:~~s ~ssess~d

^' by:he ck s on

ASSis~a~ts ~ com!,le~ions

,0 f'a's s igne d"ta'skS

ina,~e""

su'rreptitfousLy

b y

the ward,Social"Wo r k e r'and,Program

vation.

In"addi

~ion asamp:l~

^{of ch e c k's}

in<:l~dod

r cccrd Ing ob-

serviltionsof select"resi d ent s on-thetargetb~h a vi our sin- depende ntlyofAssistan~st'obs er va ti on s ; 'the s e'wer e,eem- pLeted bytheSocial Wor ke r andProgramCo-ord inatoras a

"

. -

The che c kiI nvo tv ed a,vi,sitto.'th e wardat,th e time

of

a scheduledjobcategory inor.d er todete rminethat the:

':.Assi s t a ntwas,actuallycarryi~gcut theassignedtask,;Othe

moosu:eofrel iabilitY,of staf f '~observatio ns.

Proced ureand Des i gn

ed-in"whi ch,b~ se lin e'(A)

.

an d th.e

twO

feedba ckconditi,~ns. (B and C),were,pre s e ~ t"e d,~nan'A,BA,BACAC'~sequencc.

i

L ^,

!

.!

I

.

.

," ' . ' '

.

not,told,th'atthe'proc e dur e.co ns t Ltu-t ed an"experi ment."They

were toiJ tha t ,;,' t hei~formationwa5be in g postedin'or de r toletyouk~ow'ho:""youar~''d oi ng~n'the completion~{ob·

se r vertens on.th e,,;.~b^{c atagor des f:t?m',day',t o'}da~,j.,:11

Btl'OailyW~ i tt en ;Post ed Feedba c kof T,ask Comple.tion.

scores.>'( 16days)/,,' :"During, th i s,pha s e the, '....,'"p~~gr am'Cor'ordinat~r..- poste dthepe re'en ragescores of assigned,ta s ks in the trursing s'catIcn.

Th~ , i~forillat i on

:wa s co'n'Ulne d,on

'the "Feedba~k

,

Cha i t ",'which,~~asured.appr oxLma t.eLy 5~c~.by^{'4 5im.• and} was posted co'nspicuously'on,t h e'nurs i n g statio n buU h i n

" . ' " , ' , ,

.

bear-d ,~e,~eTc enta ge C~lll~~~ion.(bot'hsc~.re s ):'fo~'A:> S ~ S ~ tan ts co LLectLve Ly wa;; presented for'twoda y s previous.and the daily,";Per c enta g eObserv~tions'completio~^I,s c ore ,:"as plott:d on

a

grap ht~r~~ghout':,~e16days.

Theinfo r ma t ionwaspo ste d'a pp r oxima tet ym id~ .o rnin'g

each'da y ,

imuiediat~ir fOllowi ng'·.th~·

^{ccnputat Ion}

'6i

^{the:p; eVi QUs}

.daY ~ 5 c~nipletion^{scores.'"A'l l}ASsist~nts^we're vC,rbal'I;'tn-.

formedof.t be".Fe edbac k Chart"bytheCo-ordi nato r,but we r e

AI''.Ba'S'e'i rrie,( 20' daysj:

.~'d~ilya'ssig~'ment syste~'foT^{Nurs in g},'A~sl stints',~as i~,'ef~ect .

~s

^{a::lrea dy}

' d~scr~b~d:. ·

""The'd a ta

i;~m"t:h'~

'; e'c or.d'

f~rms'

^wa's'

~'oinPl1'~d

^{by:'th e}

P1'6&~a:m ,C(\- Ordi~~t"ar

^\0,de t e,r mine'th;

Job s,CompletIon',:score,'btit no 'feedb a c k,or'othc r info r mat i on ..

~

regarding st a ff '5

.i~p~~~ent at'ion OfpTo!'ram~rocedures '

^{wa s}

'.:'pnt s e n t cd.

t:

r -

... . ", _., _,1:,. ': _',:', ,._' , .

Th e'in f ormat i o nwa s .pc ste d approxi.eate Ly.lIiia"ffiOrn illS

.' .',", .",," . -. " -',.' -' . '. ","

.

eachde y, ,AllAssistan tswereverbally info r medof the

.... ... - '.. . - .1

"Feedback.Ch~rt,''',.but we r en~t.t ~ld t.~ a ~the.procedu re.c ?n - ..st1 tuted."·anexperiment. The.Co- o r din ato·r.told_staffthat

.'..'the

infoTm~tion :~a's ~eing

.po's t e d'in

o~der

^{to let youlen'ow'how,"}

11 1

-~ 1

-havIcurs,

.It wasin t e nded to'imple men t both"Eeedb a c k,e ond f t i o n s :togeth~rana perina ne ntbasis fOl iow i ng'rhe la'st return,to

:,.

.

, ,' , "

baseline 'c o nd iti.ons·, ,Howeve~, ^{fiv e}nursin~·'per'~(mnelwer~'^to

.-: .. ' i , '.. ' ,: . ., '. , .. ,-J

be'transferredto the 'behavi?ur modification unir' within .the,ri.ext·,....~ek ,and they:"....e-reto.be trainedin the implemen -

t~tion,o f th7 program pr oc e d ur e s. Also;~ino -radjustmlm·t's

'-' . . ,

theresid~nt~,a r edoingonvthe

tarFe t"

behevLourefro~day'to"

day. " '~g ain, the.O~ly;questionsby:'staffwere,re~atedto fwrtber.'~xPlan~ti;'ndr.-e1aboTati~n'~f-eo e.ieed,?a~kihfor~ation..

an~the>:wereansw~r~d .diY-ccn yand~traightforwar-~lY,'b'y the'pr o g'ram

Co -~rdi~atoI':'

^.

A4,.Ba s e li ne,(-20,~a y s ): ~h e d~ily....rdt ten,po-stedfeed- .ba c kC!fresidents' pe-rfor -aance sco'resWil S·.withdrawn.andthe

." .' , ' .

condjticns"des cr-i bed inthein itia lba s e ftnewe re'i neffed~'

,.. .: C;'; (16-::,~~y~ )

^;,'

,t~e; p:oe~,~ure

^:0£

d~ily

^...

~i't.t.en " po~t~d,

feed baCk of residentsi performance,scoresvon,th eta rgetbe~

hiv',"" " ~\'imP

^{..,•.mfmted}

ag~in .·/

^as.de s e r.t bed.

:.~bOV . '

^{_, .}

,AS' (2Qdays): Withdrawal\ofdailywr~t t en.,pos~ed '..i~ e dba ek

of

re si d e n t sI per -fornencescores.on.thet.ar'getvbe>

eccnorayprog ram.

RESULTS

and assignmentof staff i'othe ,,~joh·categories.1 '.(acto;,s

r'~,~ulted

^rntheiposcpcnementjcf

. 't~e

reinstatement

~fperlo.rmance"f e e dback'as a regularfunc; ion of the,toke n'

.,"· 1;

:

Relia~'iUt~,~l

:rhe,reliability0'£,usingthe jOb.category:- rel;o r d,for ms; .· as'the"iae a s ur emen-r,of't ask'c.-omp'letdon'~asdetermin.edby hav ing

the'"ward SocialWo~kerand J?;ogram'Co '-ordin~toT:surreptitiously

.

'A~prOXillla t ~IY' Z 3t

^of'the

ti~~s

^ass-d.gned

dU~ing.'

^the

r e se'arc~' j

P:;'iOd

~ere' l;h~~ked , ~n·. ~~~s ,w~y.

^c

Th~ ,~~e,~ i~b,U

ⁱ

~y.1II~ S '

cal.culated bydividing~~:numbe r,.ofe g reeeents,on task,c o mple t i on byth: numberof."agre:inentsplus thenumberof di,sagr e e~en:-s'a'nji'mul ~

" tip'lying' 'th e'r e sult'by 100."'Tabl e ipr cvIde s"the~timber"of

ta'~ks Check~d"

andthepercentage'.

a~reelllent

w'i

o ,

"t he :A.s sisi;:nts

. '

,: ' ..-, "

' , "

" "-" , ,

for.thes.o~ial.wa.?er•.prOgramc.ll·~tdina,~or, and,~ ot hc,oln~in.ed. (The 7e were4S-Lndcpend e rit:checks'o~the'same·ta·s ~ :.,thus.' there'isa· tot al of 105di ffe r e!\t:check s).

Ai

i~dica~e d

^{on Tabl e,}

~

-'t he combined'checks

~e~l:ia

in_.an agre e_'

. ..

e

;~c .

^{Co ; 99\}

.

^{[ ' ....On.0"'}

. . , oec"i~n ~,," SSi,,;'nt ' Pre '

sent.e dacompI,ete djcb categ,oryfcrnwhen no observa tions'h a d .'

:b~en

^a:ade.

~ a~d

^-

the~e '~ere ~~o ins'Un'Ces' of Pr·ope;i; re(;~~d'ing

^,.

.:::;:::: '0;'- wi

thout

f ili~gt,-.re~o;df~r. inth'~U,~~~g

^.

\

~."' '/,,:

98.5v.'.

·1 2 8 219. (45)

305 . 30 2

Ta sk~ Ch~ckc:.d Agr ec lIl!,!nu \,'Agreeme n'ts.' ReHabilityChecks·on'completion of

Ass·ig~e,~·T~.S~^.b·t'As,s i stan ts

.Sociallfor k,e r: 130

piograIlCo -~~~U~ator : Z~,{) (SW.·- PC:Toget he r ) : (.4'5),