Performance Improvement in Behavioral Health Care: Collateral Effects of Planned Treatment Integrity Observations as an Applied Example of Schedule-Induced Responding

Abstract

With rising interest in the role of treatment integrity on student outcomes, research has primarily focused on isolating the techniques and procedures necessary to improve staff's acquisition and maintenance of adequate levels of integrity. Despite increasing numbers of publications on this topic, there has been little discussion of the variables surrounding the collection of integrity data. Using an archived database of logged integrity observations at a residential school for children with brain injury, the authors sought to examine the degree to which integrity data collection conformed to best practices of behavioral assessment with respect to temporal sequencing. Moreover, due to the agency's goal of collecting integrity on each student per month, the authors sought to examine whether the sequencing of integrity observations scalloped similarly to responding on conjunctive fixed-interval-fixed-ratio schedules. Results indicated that a majority of the staff exhibited some form of scalloping in their collection of integrity data. This article discusses possible sources of stimulus control and the potential for reactivity on the part of the teachers being observed when integrity observations are conducted in scalloped patterns. The authors conclude with a discussion on possible procedures to support the distributed collection of integrity data in applied setting.