Direct Care Personnel Research Articles

An analysis of clinical consultation activities in clinical pathology: who requests help and why.

To examine the distribution of callers who made consultation requests and to identify associations between caller categories and consultation topics. Review of prospectively collected database of consultations. Direct care personnel made more consultation requests than non-direct care personnel. Consultation topics varied by caller type. Direct care personnel requested more consultations on test interpretation and few consultations on test selection than laboratory personnel. Differences in consultation requests by primary care physicians and specialists were significant. At our laboratory, consultation requests primarily originate from primary care physicians. Consultation requests vary by caller type.

Measurement features of a long-term care quality of life (LTC-QoL) assessment scale

The issue of life quality for older people admitted for long-term care is of concern to those keen to provide services that support an acceptable quality of life. This study investigates measurement characteristics of the long-term care quality of life (LTC-QoL) assessment scale developed to address a gap in quality in life assessment in such contexts, i.e. an easy to use single scale generating summary information on the life quality experienced by all older adults in care, indicating aspects requiring attention from direct care personnel and providing management information on individual and care unit outcomes in supporting residents' experiences of life quality. Analysis of repeated LTC-QoL data for 62 long-term residents in an Australian aged care facility establishes the instrument as having good reliability and validity. Exploratory factor analysis of nine items revealed high internal consistency, good test–retest reliability, and validity across age, gender, and cognitive capacity of participants. Findings establish that the LTC-QoL has adequate reliability and dimensionality. Content validity and management utility were verified by experts using and refining the scale over 7 years in long-term care contexts, resulting in an easy to use and reliable assessment tool for long-term care recipients.

In-Service Training for Staffs of Group Homes and Work Activity Centers Serving Developmentally Disabled Adults

Results are reported for 3 years of in-service training provided to managers and direct care personnel employed in community, residential, and vocational programs for developmentally disabled adults. The data demonstrate the efficacy of the training model in that 1015 (97%) of 1080 training objectives attempted were completed by the trainees at established criterion levels. Data also indicate that a high percentage of the trainees maintained skills at criterion levels.

Curriculum resources for training Direct care providers in public Sector mental health

Direct care personnel who do not have graduate-level professional degrees provide a substantial amount of client care in mental health organizations across the nation. Training for them is minimal in many settings. This shortcoming may negatively affect client care, staff recruitment and retention, and the effective use of scarce resources. In this paper, we identify and review curriculum resources available to mental health organizations interested in implementing or enhancing training programs for direct care personnel. These include two relevant competency sets and six portable training curricula, as well as information on how to access these resources.

Factors associated with victimization of personnel in emergency departments

Objective The purpose of this study was to identify the incidence of ED personnel victimization in Central Florida and examine its relationship to victims’ reports of 3 factors: characteristics of the patient/perpetrator, characteristics of the personnel victimized, and characteristics of the ED environment. Methods Data were collected anonymously in a mail survey using 37 items from Mahoney’s Emergency Department Victimization Questionnaire (EDVQ) and a demographic questionnaire. Chi square, Spearman’s rank correlation coefficient, and Pearson’s product moment correlation were used to describe frequencies, incidence, and their relationships to the variables studied. A sample of 226 of the 600 direct care personnel (37%) from 18 of the 19 hospital emergency departments in a tri-county area (95%) participated. Results The incidence of physical assault was reported to be 42% during the past year and 72% during the respondents’ careers. Alcohol use was associated with incidence (1-tailed Pearson; P = .001). Verbal abuse was significantly higher on day shift ( P = .043). The most desired environmental variable was 24-hour security attendants, available to 51.8% of the respondents. More than a fourth of the subjects reported that they had completed no coursework or had no continuing education in violence prevention. Discussion Respondents reported avoiding identification on duty, underreporting, postvictimization staff turnover, dissatisfaction with security, and the desire for every security provision listed. The goals of reducing the fears and victimization of ED personnel should become a priority within the health care system. (J Emerg Nurs 1999;25:361-6)

Integrating instructional procedures into traditional congregate care situations for people with severe disabilities

AbstractMany institutional and community residential agencies experience difficulties in providing habilitative services when direct care staff are working with groups of people with severe disabilities. We evaluated a means of assisting direct care personnel in integrating instructional strategies into traditional congregate care situations. In Experiment 1, integrated teaching strategies were operationalized for two direct care staff persons. The strategies were based on individualized client habilitative goals and the use of brief response prompting and contingent reinforcement paradigms. The staff members integrated the teaching procedures into their group routines with clients upon implementation of an integrated‐teaching staff training and management program. The program involved two staff training sessions and ongoing performance feedback. In Experiment 2, four staff members in another living unit integrated the strategies into their group routines upon implementation of a simplified version of the program. Additionally, while the program was in effect, adaptive behaviors increased in frequency for 19 of 20 clients with profound multiple disabilities. Results of the experiments demonstrate a means through which residential agencies may enhance provision of continuous active treatment in accordance with clinical and governmental guidelines. Suggestions for future rescarch are provided, focusing on overcoming obstacles residential personnel face in providing treatment services in congregate situations.

A program for increasing manual signing by a nonvocal adult within the daily environment

AbstractAn instructional program was implemented to increase an adult's repertoire of manual signlanguage skills. The participant was a 39‐year‐old male with mental retardation who had never demonstrated vocal speech. The program used modified incidental teaching strategies consisting of modeling, verbal prompts, physical guidance, positive reinforcement, and naturally occurring reinforcers within the participant's daily environment. The teaching program was implemented by eight direct care personnel who interacted with the participant and five other residents in a community living arrangement (CLA) on a daily basis. Results indicated that the participant learned to independently use manual signing during structured interactions and that the independent levels of responding were maintained for the duration of this study. Results are discussed regarding the potential benefits of teaching manual signs to nonvocal individuals.

Improving residential treatment services: implementation and norm-referenced evaluation of a comprehensive management system.

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 and evaluated a comprehensive management system designed to improve such services. 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.

Adaptive Behavior and Low Incidence Handicaps

Individuals who have physical impairments are a very heterogeneous group. Teachers and other direct care personnel of the physically handicapped have traditionally received medical diagnoses and medical information with very few educational and/or treatment implications. The use of adaptive behavior scales with the physically handicapped offers a functional assessment tool that can be directly applied to individual treatment plans. This article examines problems in the traditional assessment procedures used with the physically handicapped and discusses the use of adaptive behavior scales with emphasis on application of the results through a multidisciplinary approach. Selected adaptive behavior scales are described, and guidelines for test administration with the physically handicapped are suggested.

Inservice Training for Staffs of Group Homes and Work Activity Centers Serving Developmentally Disabled Adults

Results are reported for 3 years of inservice training provided to managers and direct care personnel employed in community, residential, and vocational programs for developmentally disabled adults. The data demonstrate the efficacy of the training model in that 1015 (97%) of 1080 training objectives attempted were completed by the trainees at established criterion levels. Data also indicate that a high percentage of the trainees maintained skills at criterion levels.

A program for increasing manual signing by autistic and profoundly retarded youth within the daily environment.

A program was implemented to increase the manual signing of five profoundly retarded and four autistic youth within their daily environment. Each participant was nonvocal or minimally vocal. The program was based on modified incidental teaching strategies and was implemented by direct care personnel under supervision in an institutional setting. Specific components included rearranging the physical environment to prompt signing, altering routine staff-resident interactions to prompt, manually guide and/or reinforce signing; and conducting mini-training sessions. Additionally, staff modeled signs intermittently throughout the day. The program was sequentially implemented during two staff work shifts on each of two resident living modules. Observations conducted at four separate time periods during the day indicated that significant increases in signing occurred for all participating youth and that the increases generally maintained during follow-up checks at 5 and 17 weeks. Differential effects of the increased signing on frequency of vocalizations were noted across residents. A staff acceptability survey indicated favorable staff reports on the usefulness of signing to communicate with the youth. Results are discussed regarding the significance of manual signing for seriously developmentally disabled persons and the importance of ensuring that signing skills are used in the daily environment and not exclusively in formal training sessions. Also, areas for continued research are noted in terms of more refined analyses of client skills and subsequent progress in manual communication programs.

The development of a technical assistance system for residential treatment programs

Using a technical assistance model, the authors developed a University-based program to facilitate staff development among direct care personnel in a network of community-based residential treatment programs serving emotionally disturbed children and adolescents in North Carolina. The process used and the results are described, followed by the implications of this program for child and youth services professionals.

Reported Skills of Chosen Children

A study was set up to test 6 hypotheses concerning the reliability of interview data about self help skills of retarded children, the differences in reliability of reports on the skills of children who were or were not in special programs, the probability of being liked as a function of the child's competence in comparison with ward mates, and the reliability of interview data on self help skills of infants. Children were observed repeatedly by trained, experience staff; interviews were conducted with direct care personnel; assignment of children for observations and interviews was counterbalanced. The Vineland Social Maturity Scale and a “likeability” measure were used. Only partial support was obtained for the hypothesis concerning infants; all other hypotheses were clearly supported.