Limited Supervision Research Articles

Country Immunization Information System Assessments - Kenya, 2015 and Ghana, 2016.

The collection, analysis, and use of data to measure and improve immunization program performance are priorities for the World Health Organization (WHO), global partners, and national immunization programs (NIPs). High quality data are essential for evidence-based decision-making to support successful NIPs. Consistent recording and reporting practices, optimal access to and use of health information systems, and rigorous interpretation and use of data for decision-making are characteristics of high-quality immunization information systems. In 2015 and 2016, immunization information system assessments (IISAs) were conducted in Kenya and Ghana using a new WHO and CDC assessment methodology designed to identify root causes of immunization data quality problems and facilitate development of plans for improvement. Data quality challenges common to both countries included low confidence in facility-level target population data (Kenya=50%, Ghana=53%) and poor data concordance between child registers and facility tally sheets (Kenya=0%, Ghana=3%). In Kenya, systemic challenges included limited supportive supervision and lack of resources to access electronic reporting systems; in Ghana, challenges included a poorly defined subdistrict administrative level. Data quality improvement plans (DQIPs) based on assessment findings are being implemented in both countries. IISAs can help countries identify and address root causes of poor immunization data to provide a stronger evidence base for future investments in immunization programs.

Clinical reasoning and knowledge management in final year medical students: the role of Student-led Grand Rounds.

ObjectivesThe development of clinical reasoning and decision-making skills is often limited in medical school curricula. In reality, medical graduates acquire these skills during their first few years of residency. For many, this can be stressful as they may be working under limited supervision as a part of their rotations.MethodsStudent-led Grand Rounds was developed to transfer both explicit and tacit knowledge to final year medical students. This pilot project was to apply the principles of knowledge management to allow students to be exposed to the reasoning and decision making of common clinical presentations. Student feedback through questionnaires was collated at the end of the program.ResultsBased on feedback and focus groups, modifications were made to produce a stable program in subsequent clinical rotations. Formal feedback was collated from all the 76 students who participated in the first year. This represented 100% of the cohort for this clinical school for that year. There was a 100% response rate as the feedback forms were given and collected at the end of the last session per block. The student responses were both in ratings defined in a feedback forms and in written comments. A total of 74 of the 76 students rated the program highly. They enjoyed the nonthreatening interactions. The remaining two students preferred more didactic teaching.ConclusionThis initiative allows an efficient transfer and utilization of knowledge. This could maximize the acquisition of practical knowledge by medical students as they finish their course in the transition to graduate medical practice.

Using Registered Dental Hygienists to Promote a School-Based Approach to Dental Public Health.

We examine a strategy for improving oral health in the United States by focusing on low-income children in school-based settings. Vulnerable children often experience cultural, social, economic, structural, and geographic barriers when trying to access dental services in traditional dental office settings. These disparities have been discussed for more than a decade in multiple US Department of Health and Human Services publications. One solution is to revise dental practice acts to allow registered dental hygienists increased scope of services, expanded public health delivery opportunities, and decreased dentist supervision. We provide examples of how federally qualified health centers have implemented successful school-based dental models within the parameters of two state policies that allow registered dental hygienists varying levels of dentist supervision. Changes to dental practice acts at the state level allowing registered dental hygienists to practice with limited supervision in community settings, such as schools, may provide vulnerable populations greater access to screening and preventive services. We derive our recommendations from expert opinion.

Perceptions of healthy eating amongst Indian adolescents in India and Canada

IntroductionDietary patterns have contributed to the rising prevalence of overweight and obesity among Indian adolescents. Yet there are limited studies on their perspectives on healthy eating. The purpose of this study was to understand perceptions and attitudes of Indian-origin adolescents in India and Canada that may contribute to healthy eating behaviour. MethodsQualitative data collection and analysis of 13 focus group discussions (FGD) was conducted among 34 boys and 39 girls (total number of participants: 73) of different weight and socioeconomic status (SES) in rural and urban India, and urban Canada aged 11–18 years. ResultsAll adolescents perceived homemade foods, and foods high in vitamins, minerals and fiber as healthy. Rural Indian adolescents also identified contaminant-free food as important. Opinions differed regarding the health value of consuming meat, and amongst Canadian adolescents, the health impact of Western versus Indian diets. Identified benefits of healthy eating included improved energy for Indians, and disease prevention for Canadians and urban Indians. Identified barriers across all settings included peers; and availability, access and affordability of unhealthy foods. Urban Indians and Canadian girls also reported academic stress and lack of time as barriers. Canadian girls reported limited parental supervision during mealtimes as an additional barrier. Facilitators to healthy eating included parents, friends and personal preferences for healthy foods. ConclusionThis study suggests potential targets for family-based and school-based education programs and policies to improve dietary habits of Indian and Indo-Canadian adolescents which include, culturally focused nutrition education and guidelines, academic stress management strategies, parental education, food hygiene regulations and restriction on the sale and advertising of unhealthy foods.

Evaluation of Text Messaging Effects on Health Goal Adherence in the Management of Participants With Chronic Diseases.

The study purpose was to determine whether text messaging health-related messages, questions, and reminders to community case management participants with chronic diseases increased health goal adherence. This study was conducted by a rural community case management, hospital-affiliated program. This pilot, quasiexperimental study measured health goal adherence, the degree to which an individual continues work toward self-identified health goals under limited supervision, before and after a text messaging intervention. All participants were receiving community case management services for chronic disease. Participants completed baseline and follow-up surveys regarding a text messaging intervention. Most participants were African Americans, had diabetes, with equal numbers by gender, an average age of 57.8 years, and had been in the community case management program for 3-5 years. Participants were sent a total of 1,654 messages/questions and 571 reminders. At follow-up, respondents who reported "Did you work on your health goals?" increased significantly (p = .0430). However, no differences were found for "Did you go to your health care appointments?" and "Did you take your medicines as you should?" No differences were noted in reported visits/hospitalizations overall or specifically at the research site. Lastly, study member visit/hospitalization numbers did not change significantly at follow-up. Although text messaging is not meant to take the place of face-to-face interactions, it does provide community case managers with an additional modality of communication with patients to offer support and important care reminders, and to facilitate patient participation in his or her care.

Attending to Nuanced Emotions: Fostering Supervisees' Emotional Awareness and Complexity

There is limited supervision research exploring how supervisees learn emotional awareness and complexity. In this article, the 5 levels of emotional awareness and 3 aspects of emotional complexity are explored in light of the supervision enterprise. In addition, 2 supervision intervention guides and a case example are provided.

Understanding the role of intersectoral convergence in the delivery of essential maternal and child nutrition interventions in Odisha, India: a qualitative study

BackgroundConvergence of sectoral programs is important for scaling up essential maternal and child health and nutrition interventions. In India, these interventions are implemented by two government programs – Integrated Child Development Services (ICDS) and National Rural Health Mission (NRHM). These programs are designed to work together, but there is limited understanding of the nature and extent of coordination in place and needed at the various administrative levels. Our study examined how intersectoral convergence in nutrition programming is operationalized between ICDS and NRHM from the state to village levels in Odisha, and the factors influencing convergence in policy implementation and service delivery.MethodsSemi-structured interviews were conducted with state-level stakeholders (n = 12), district (n = 19) and block officials (n = 66), and frontline workers (FLWs, n = 48). Systematic coding and content analysis of transcripts were undertaken to elucidate themes and patterns related to the degree and mechanisms of convergence, types of actions/services, and facilitators and barriers.ResultsClose collaboration at state level was observed in developing guidelines, planning, and reviewing programs, facilitated by a shared motivation and recognized leadership for coordination. However, the health department was perceived to drive the agenda, and different priorities and little data sharing presented challenges. At the district level, there were joint planning and review meetings, trainings, and data sharing, but poor participation in the intersectoral meetings and limited supervision. While the block level is the hub for planning and supervision, cooperation is limited by the lack of guidelines for coordination, heavy workload, inadequate resources, and poor communication. Strong collaboration among FLWs was facilitated by close interpersonal communication and mutual understanding of roles and responsibilities.ConclusionsCongruent or shared priorities and regularity of actions between sectors across all levels will likely improve the quality of coordination, and clear roles and leadership and accountability are imperative. As convergence is a means to achieving effective coverage and delivery of services for improved maternal and child health and nutrition, focus should be on delivering all the essential services to the mother-child dyads through mechanisms that facilitate a continuum of care approach, rather than sectorally-driven, service-specific delivery processes.

Adapting to a Challenging Fieldwork: Understanding the Ingredients

Two occupational therapy students were assigned to an inpatient psychiatric unit for their first Level 1 fieldwork. With limited on-site supervision provided, they looked to each other for peer support and collaboration in assisting one patient with severe depression who was considered the “sickest patient on the unit.” The students were able to work together and make a positive intervention with this patient despite their novice status. Understanding what each of them brought personally to this experience as well as the nature of their working relationship and their use of concepts taught in the classroom has important implications for occupational therapy education. One of the profession’s goals in acute psychiatric settings is to engage clients in meaningful occupations to facilitate rehabilitation and the recovery process. The two students skillfully employed the concepts of emotional intelligence, cultural competence, and therapeutic use of self and demonstrated their comfort with technology and spirituality to facilitate his occupational reengagement. By examining this case report through the lens of the literature on emotional intelligence, cultural competence, and therapeutic use of self, the ingredients of their clinical reasoning becomes more transparent and available to other occupational therapy educational programs.

Burnout, Stress and Direct Student Services Among School Counselors

The American School Counselor Association (ASCA; 2012) recommends that school counselors enhance the personal, social, academic and career development of all through the organization and facilitation of comprehensive programmatic counseling services. Delivery of student services is part of a larger framework articulated by ASCA's National Model (2012) that also includes management, accountability and foundation components of school counseling programs. However, ASCA notes that school counselors should spend 80 percent or more of their time in direct and indirect services to students (ASCA, 2012, p. xii). ASCA defines indirect student services as services that are in support of and involve interactions (e.g., referrals, consultations, collaborations and leadership) with stakeholders other than the student (e.g., parents, teachers and community members). On the other hand, direct student services are interactions that occur face-toface and involve the facilitation of curriculum (e.g., classroom guidance lessons), individual student planning and responsive services (e.g., individual, group and crisis counseling). In either case, ASCA charges school counselors with prioritizing the delivery of student services.As a part of their work, school counselors often incur high levels of stress that may result from multiple job responsibilities, role ambiguity, high caseloads, limited resources for coping and limited clinical supervision (DeMato & Curcio, 2004; Lambie, 2007; McCarthy, Kerne, Calfa, Lambert, & Guzman, 2010). In addition, burnout can result from the ongoing experience of stress (Cordes & Dougherty, 1993; Maslach, 2003; Schaufeli & Enzmann, 1998) and can result in diminished or lower quality rendered services (Lawson & Venart, 2005; Maslach, 2003). While research on burnout is common in the school counseling literature (Butler & Constantine, 2005; Lambie, 2007; Wachter, Clemens, & Lewis, 2008; Wilkerson & Bellini, 2006), studies have not focused on the relationship between burnout and school counselors' service delivery. Yet, burnout has the potential to produce negative consequences for the work rendered by school counselors and could result in fewer services for (Lambie, 2007; Lawson & Venart, 2005; Maslach, 2003). Therefore, the purpose of this research was to examine the contribution of school counselors' levels of burnout and stress to their delivery of direct student services.School Counselors and the Delivery of Student ServicesResearch on school counselors' delivery of student services has produced positive findings. In a meta-analysis that included 117 experimental studies, Whiston, Tai, Rahardja, and Eder (2011) identified that, in general, school counseling services have a positive influence on students' problemsolving and school behavior. Furthermore, in schools where school counselors completed higher levels of student services focused on improving academic success, personal and social development, and career and college readiness, experienced a variety of positive outcomes, such as increased sense of belongingness, increased attendance, fewer hassles with other students, and less bullying (Dimmitt & Wilkerson, 2012). Moreover, researchers have shown that the higher occurrence of school counselor-facilitated services is beneficial for students' educational experience and academic outcomes (Carey & Dimmitt, 2012; Lapan, Gysbers, & Petroski, 2001; Wilkerson, Perusse, & Hughes, 2013). Overall, the services conducted by school counselors have a positive impact on student success. As such, research investigating the factors related to higher incidence of school counselors' direct student services could provide significant educational benefits to schools.Researchers have examined a variety of topics that relate to increased student services. Clemens, Milsom, and Cashwell (2009) found that if school counselors had a good relationship with their principal and were engaged in higher levels of advocacy, they were likely to have increased implementation of programmatic counseling services. …

Software Framework for Controlling Unsupervised Scientific Instruments.

Science outreach and communication are gaining more and more importance for conveying the meaning of today’s research to the general public. Public exhibitions of scientific instruments can provide hands-on experience with technical advances and their applications in the life sciences. The software of such devices, however, is oftentimes not appropriate for this purpose. In this study, we describe a software framework and the necessary computer configuration that is well suited for exposing a complex self-built and software-controlled instrument such as a microscope to laymen under limited supervision, e.g. in museums or schools. We identify several aspects that must be met by such software, and we describe a design that can simultaneously be used to control either (i) a fully functional instrument in a robust and fail-safe manner, (ii) an instrument that has low-cost or only partially working hardware attached for illustration purposes or (iii) a completely virtual instrument without hardware attached. We describe how to assess the educational success of such a device, how to monitor its operation and how to facilitate its maintenance. The introduced concepts are illustrated using our software to control eduSPIM, a fluorescent light sheet microscope that we are currently exhibiting in a technical museum.

CURRICULUM COMPETENCES MANIFESTED BY PUBLIC AND PRIVATE SECONDARY SCHOOL ADMINISTRATORS FOR CLINICAL SUPERVISION IN ANAMBRA STATE

Clinical supervision is a process of facilitating the professional growth of a teacher, primarily by observing teacher’s instructional practices, giving the teacher the feedback about classroom interactions and helping the teacher make use of that feedback to make teaching more effective. Its effectiveness depends on the competences of the supervisors that carry it out. This study assessed the curriculum competencies manifested by private and public secondary school administrators in Anambra State during clinical supervision. The study was guided by two research questions and one null hypothesis. Sample involved 1,378 respondents (comprising 962 public and 416 private school staff respectively) selected through the multistage procedure. Data was collected through a researcher-developed questionnaire containing 10 items each on a 4-point scale. Mean scores were used to answer the research questions, while the t-test was used in testing the null hypothesis at the 0.05 level of significance. The findings indicated that public and private secondary school administrators in Anambra State secondary schools manifested only a few out of the variety of curriculum competencies for effective clinical supervision. The manifestations of these clinical supervision competencies were higher in private than in public schools. However, both administrators manifested limited clinical supervision competencies. By implication, this situation has the potential of hindering effective instructional supervision of public and private secondary schools in the State. Based on the findings and implication, it was recommended among other things that the public and private secondary school administrators should give emphasis to and seek avenues for significant improvements in their teaching, human relations, resource management and evaluation competencies. Reading professional journals, peer mentoring, and participating in professional conferences and seminars would help them to improve their clinical supervision competencies. Article visualizations:

Teacher assistant support and deployment in mainstream schools

ABSTRACTModels of support for students with disability and learning difficulties in mainstream classes in Australia rely extensively on teacher assistants (TAs). Current models, however, inadvertently perpetuate low expectations because providing TA support can be one of the most restrictive supports offered in a school [Giangreco, M. F. 2010a. “One-to-One Paraprofessionals for Students with Disabilities in Inclusive Classrooms: Is Conventional Wisdom Wrong?” Intellectual and Developmental Disabilities 48 (1): 1–13; Etscheidt, S. 2005. “Paraprofessional Services for Students with Disabilities: A Legal Analysis of Issues.” Research and Practice for Persons with Severe Disabilities 30(2): 60–80]. In addition, the increasing instructional role of TAs in the classroom is concerning. Negative outcomes for students where TAs provide support have been noted [Giangreco, M. F., J. C. Suter, and M. B. Doyle. 2010. “Paraprofessionals in Inclusive Schools: A Review of Recent Research.” Journal of Educational and Psychological Consultation 20: 41–57; Webster, R., P. Blatchford, and A. Russell. 2010. “Should Teaching Assistants Have a Pedagogical Role? Lessons Following the DISS Project.” Paper Presented at the BERA annual conference, September 1–4, University of Warwick, UK]. A qualitative case study was conducted in an Australia city over three years across four primary school sites to identify the issues and propose possible solutions. The study identified five different models of TA support and deployment. It was found support models used in mainstream schools were generally inequitable – if students did not have a disability or learning difficulty they received instruction primarily from a qualified teacher, but if students had a disability or learning difficulty, they received instruction from a TA who may have had no qualifications, no involvement in planning, limited supervision and unclear reporting; and no clear duty statement requirements. A more inclusive and more equitable model of TA support is discussed.

How to Train Experienced Therapists in a New Method: A Qualitative Study into Therapists' Views.

Implementation of new effective treatments involves training, supervision and quality control of therapists, who are used to utilize other methods. Not much is known about therapists' views on how new psychotherapy methods should be taught. The purpose of this study is to get insight in how experienced therapists experience the training in a new method so that training methods for experienced therapists can be improved. Qualitative research using focus groups. For an RCT on the effectiveness of schema therapy (ST) for six personality disorders more than 80 therapists were trained in ST. They applied the ST-protocol after 4-day training, with peer supervision and limited expert supervision. Sixteen of these trained ST therapists from seven health institutions participated in the focus groups. The transcripts and records of the focus groups were analyzed on repeating themes and subthemes and in terms of higher order categories. Therapists appreciated didactical learning methods but particularly valued experiential learning. Especially, novice ST therapists missed role plays, feedback to learn required skills and attitudes, and attention to their resistance to new techniques (e.g., empathic confrontation and imagery). Peer supervision gave emotional recognition, but therapists lacked regular advice from an ST-expert. In teaching a new therapeutic method didactic teaching is necessary, but experiential learning is decisive. Experiential learning includes practicing the new therapy and reflecting on one's experiences, including resistance against new methods. Emphatic confrontation, case conceptualization, role play, peer supervision and opportunities to ask an expert supervisor during peer supervision are found to be helpful. Copyright © 2016 John Wiley & Sons, Ltd. Especially by Eperiential learning besides didactic learning. By practicing with many role plays including feedback. By reflecting on one's experiences including resistance against ingredients of the new method. By peer supervision with opportunities to ask an expert supervisor.

Commentaries on health services research

Commentaries on health services research

Bayesian Joint Modelling for Object Localisation in Weakly Labelled Images.

We address the problem of localisation of objects as bounding boxes in images and videos with weak labels. This weakly supervised object localisation problem has been tackled in the past using discriminative models where each object class is localised independently from other classes. In this paper, a novel framework based on Bayesian joint topic modelling is proposed, which differs significantly from the existing ones in that: (1) All foreground object classes are modelled jointly in a single generative model that encodes multiple object co-existence so that "explaining away" inference can resolve ambiguity and lead to better learning and localisation. (2) Image backgrounds are shared across classes to better learn varying surroundings and "push out" objects of interest. (3) Our model can be learned with a mixture of weakly labelled and unlabelled data, allowing the large volume of unlabelled images on the Internet to be exploited for learning. Moreover, the Bayesian formulation enables the exploitation of various types of prior knowledge to compensate for the limited supervision offered by weakly labelled data, as well as Bayesian domain adaptation for transfer learning. Extensive experiments on the PASCAL VOC, ImageNet and YouTube-Object videos datasets demonstrate the effectiveness of our Bayesian joint model for weakly supervised object localisation.

1/3. Hope and despair: the community health assistant role in Zambia

Background: In order to address the challenges facing the community-based health workforce in Zambia, its Ministry of Health implemented the national community health assistant strategy in 2010. The strategy aims to address the challenges by creating a new group of workers called ‘community health assistants’ (CHAs) and integrating them into the health system. The first group started working in August 2012. The objective of this paper is to document their motivation to become a CHA, their experiences of working in a rural district, and how these experiences affected their motivation to work. Methods: A phenomenological approach was used to examine CHAs' experiences. Data collected through in-depth interviews with 12 CHAs in Kapiri Mposhi district, Zambia, and observations were analysed using a thematic analysis approach. Results: Personal characteristics, such as previous experience and knowledge, passion to serve the community and a desire to improve skills, motivated people to become CHAs. Health systems characteristics, such as an inclusive work culture in some health posts, motivated CHAs to work. Conversely, a non-inclusive work culture created a social structure that constrained CHAs' ability to learn, to be innovative and to effectively conduct their duties. Further, limited supervision, misconceptions about CHA roles, poor prioritisation of CHA tasks by some supervisors, as well as non- and irregular payment of incentives also adversely affected CHAs' ability to work effectively. In addition, negative feedback from some colleagues at the health posts affected some CHAs' self-confidence and professional outlook. In the community, respect and support provided to CHAs by community members instilled a sense of recognition, appreciation and belonging in CHAs, which inspired them to work. On the other hand, limited drug supplies and support from other community-based health workers, due to their exclusion from the government payroll, inhibited CHAs' ability to deliver services. Conclusions: Programmes aimed at integrating community-based health workers into health systems should adequately consider multiple incentives, effective management, supervision and support from the district. These should be tailored towards enhancing the individual, health system and community characteristics that positively impact work motivation at the local level if such programmes are to effectively contribute towards improved primary healthcare.

Project-based Learning and Its Validity in a Thai EFL Classroom

Project-based learning is often said to promote the intellectual and social development of students, for it requires them to actively participate in the process of acquiring knowledge and skills with limited teacher supervision. The success of project-based learning, therefore, depends almost entirely upon the ability of students to be initiative and to function with a degree of autonomy. Literature has shown that most Thai students prefer to remain within the comfort zone of the traditional EFL classroom, where the teacher's intense guidance is dominant and appreciated. Thus, this study seeks to ascertain to what extent the project-based learning can be applied to an actual English language classroom in Thai culture. The subjects of this study were 21 third-year students, who were part of the 2013 Communication Arts Outstanding Students Program at Bangkok University. The subjects took pre- and post-tests before and after the treatment respectively to provide data for a t-test analysis of the difference between their pre-existing English language levels and their levels at the end of the 12-week program. As the subjects progressed in the project-based learning process, they were also asked to keep journals and were interviewed to reflect on their learning experience in order to provide data for qualitative content analysis. Findings indicated that the project-based EFL classroom yielded not only positive learning outcomes, but also helped the students to improve their cognition, work ethics, and interpersonal skills. Further studies were recommended to provide more empirical contributions with the objective of proving the effectiveness of project-based learning in EFL classrooms in other cultural contexts.

PSF: A Unified Patient Similarity Evaluation Framework Through Metric Learning With Weak Supervision.

Patient similarity is an important analytic operation in healthcare applications. At the core, patient similarity takes an index patient as the input and retrieves a ranked list of similar patients that are relevant in a specific clinical context. It takes patient information such as their electronic health records as input and computes the distance between a pair of patients based on those information. To construct a clinically valid similarity measure, physician input often needs to be incorporated. However, obtaining physicians' input is difficult and expensive. As a result, typically only limited physician feedbacks can be obtained on a small portion of patients. How to leverage all unlabeled patient data and limited supervision information from physicians to construct a clinically meaningful distance metric? In this paper, we present a patient similarity framework (PSF) that unifies and significantly extends existing supervised patient similarity metric learning methods. PSF is a general framework that can learn an appropriate distance metric through supervised and unsupervised information. Within PSF framework, we propose a novel patient similarity algorithm that uses local spline regression to capture the unsupervised information. To speedup the incorporation of physician feedback or newly available clinical information, we introduce a general online update algorithm for an existing PSF distance metric.

Document Clustering With Dual Supervision Through Feature Reweighting

Traditional semi‐supervised clustering uses only limited user supervision in the form of instance seeds for clusters and pairwise instance constraints to aid unsupervised clustering. However, user supervision can also be provided in alternative forms for document clustering, such as labeling a feature by indicating whether it discriminates among clusters. This article thus fills this void by enhancing traditional semi‐supervised clustering with feature supervision, which asks the user to label discriminating features during defining (labeling) the instance seeds or pairwise instance constraints. Various types of semi‐supervised clustering algorithms were explored with feature supervision. Our experimental results on several real‐world data sets demonstrate that augmenting the instance‐level supervision with feature‐level supervision can significantly improve document clustering performance.

Using camera-glasses for the assessment of aggressive behaviour among adolescents in residential correctional care: a small-scale study

Purpose– The purpose of this paper is to examine naturally occurring episodes of aggressive interaction among adolescents in residential correctional programmes. The aims of our study were twofold. First, the development of a new camera-glasses method, and second, the method's applicability in the study of aggressive adolescents in residential care.Design/methodology/approach– Based on a mobile assessment strategy, the paper developed a new methodology for in-the-field recording of environmental conditions in which aggressive behaviour arises. The authors used glasses with an inbuilt camera worn by research subjects to record observational data. In the particular study presented here the authors used camera-glasses to observe the material and social environments of eight aggressive adolescents in a residential treatment programme and of a contrast group of four non-aggressive adolescents living at home.Findings– The crucial methodological findings are that camera-glasses successfully record the social and physical environments of aggressive adolescents from their perspective in relation to their environment and interlocutors, and that the camera-glasses method does not generate high reactivity. The results show that aggressive adolescents in residential care use direct and reactive forms of aggression, and that their aggressive behaviours occur predominantly in settings with limited adult supervision. In residential care aggressive behaviour is, paradoxically, an effective strategy for individuals to gain regard and social status among peers and to push their interests among staff.Research limitations/implications– An obvious limitation is the reliance on a small sample which limits the generalisation of the results.Practical implications– For residential facilities it is crucial to reduce the occurrence of low supervised social situations in order to minimise peer contagion. Furthermore, staff and educators need to be trained to use deescalating response strategies when dealing with adolescents’ aggressive behaviour, precisely deescalating strategies which neither involve acquiescence nor surrender to pressure.Originality/value– Our investigations demonstrate that the camera-glasses method is a promising new assessment technique which has applicability in various fields of adolescent research.