Improving day-treatment services for adults with severe disabilities: a norm-referenced application of outcome management.
A six-step outcome loop with norm-referenced goals lifts client and staff behavior for at least a year in adult day programs.
01Research in Context
What this study did
Staff in an adult day program ran a six-step loop. They set norm-referenced goals, watched data, trained each other, and gave feedback.
The adults had severe intellectual disabilities. The team wanted more on-task behavior and more teaching moves from staff.
What they found
Client engagement rose above the baseline level and above the national norm. Staff teaching moves also jumped up.
The gains lasted at least one year with no extra bonuses.
How this fits with other research
Reid et al. (2005) ran almost the same loop, but with clinicians in charge. Both studies saw lasting staff and client gains. The 2004 paper shows managers can drive the loop; the 2005 paper shows clinicians can too.
Greene et al. (1978) tried a simpler fix: post client graphs on the wall. That alone beat supervisor praise. Ganz et al. (2004) folded that idea into a full six-step package.
Lindsley (1992) let staff monitor each other instead of using bosses. Only four of six teachers improved, and the gains faded. The 2004 manager-led loop produced steadier results.
Why it matters
If you run an adult day program, steal the loop. Pick a norm-based target, graph it daily, train with modeling and rehearsal, and give brief verbal feedback. Do it weekly. You should see client engagement climb within a month, and the data will defend your program at audit time.
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02At a glance
03Original abstract
We evaluated an outcome management program for working with staff to improve the performance of adults with severe disabilities in a congregate day-treatment setting. Initially, observations were conducted of student task involvement and staff distribution of teaching interactions across students in four program sites. Using recent normative data to establish objective goals for student performance, management intervention was warranted in two of the sites. A six-step outcome management program was then implemented in the two sites. The program involved defining desired student and staff outcomes, systematic monitoring of the outcomes, staff training, and supportive and corrective feedback. The outcome management program was accompanied by increases in student on-task behavior and staff distribution of teaching interactions in both sites. The increases brought the levels of on-task behavior above the normative average; on-task behavior was maintained above the baseline average for over 1 year in both sites. These results are discussed in terms of the benefits of relying on normative data for objectively evaluating and improving service delivery systems. Discussion of future research needs focuses on applying the outcome management program to other settings and services for people with disabilities.
Journal of applied behavior analysis, 2004 · doi:10.1901/jaba.2004.37-365