Regular Performance Feedback Research Articles

The 6 Biggest Mistakes Leaders Make When Motivating Employees

Abstract: This article examines key factors that demotivate employees based on research in organizational psychology and leadership theory. It identifies a lack of feedback and praise, unclear or misaligned goals, limited autonomy and decision-making power, insufficient opportunities for skills development and growth, unrealistic workload expectations, and poor communication as universal demotivators across organizational contexts. Specific examples from the automotive industry illustrate how these issues negatively impact motivation. The article maintains that while individualized approaches are needed, certain demotivating behaviors should be avoided, such as not providing regular performance feedback or recognition. It advocates for goal setting, autonomy-enhancing problem solving, targeted skills training programs, reasonable workload calibration, and transparent communication as evidence-based ways to meaningfully boost employee engagement. The conclusion reiterates that leadership equipped with motivation science can focus on empowering rather than discouraging employees through these best practices.

Increasing Screening Rates for Comorbidities in Adolescents with Elevated Body Mass Index in Pediatric Primary Care.

Adolescents with elevated body mass index are at increased risk for comorbidities such as dyslipidemia, diabetes mellitus, and metabolic dysfunction-associated steatotic liver disease. Guideline-based screening can identify impacted patients early, allowing for lifestyle modifications and other treatments to improve long-term health. Unfortunately, only 20% of pediatric patients with obesity receive recommended screening. A multidisciplinary quality improvement team designed and implemented a project to improve comorbidity screening utilizing the Model for Improvement. Provider education and incentive, clinical decision support, and regular performance feedback were chosen as interventions. Screening rates were tracked on a statistical process control chart. From March through December of 2022, 9547 pediatric patients aged 10 years and up with body mass index greater than or equal to the 95th percentile were seen for preventive care visits. Screening rates for comorbidities increased from a baseline of 19.5%-58% and were sustained for over 3 months. Numerous patients at risk for chronic disease were identified. Evidence-based clinical decision support, along with provider education and engagement, can effectively increase screening rates for comorbidities in pediatric patients with obesity.

Career Development and Employee Performance in Public Institutions in Rwanda: Case of Rwanda Housing Authority

This research looked at career development system through the lenses of personal growth, advancement and challenging responsibilities against Quality of services, Task’s completion, Team work, Dependability and reliability and Creativity of employee performance in Rwanda’s public institutions, with the Rwanda Housing Authority (RHA) case study. It was grounded on the Hertzberg and Vroom Expectancy Theories of career development. The study adopted a mixed design, combining a descriptive quantitative and a phenomenology qualitative design. The target population consisted of 108 respondents from whom 85 were statistically drawn using Yamane 1967 formula. The study found that majority of respondents believe RHA offers significant career growth opportunities and maintains an active career planning policy. The average response score of 4.45 suggests that respondents generally believe that career development efforts at RHA effectively influence employee performance. The regression analysis further quantifies this relationship, demonstrating that career development accounts for 42% of the variation in employee performance, reinforcing the crucial role that such initiatives play. The analysis of variance (ANOVA) corroborates this strong correlation, exhibiting statistical significance that points to career development as a substantial influencer of performance. In terms of specific impact, the coefficient of career development, 0.588, indicates that for every unit increase in career development, there is a near 0.6 unit increase in staff performance. The study recommends it is crucial to significantly invest in and emphasize career development initiatives, considering their key role in enhancing employee performance. These initiatives should include personalized career development plans, mentorship programs, and regular training sessions for all employees. Regular performance reviews and feedback sessions can help identify areas of improvement and direct career development efforts. Furthermore, all employees, regardless of their roles, should have equal access to these career development opportunities, promoting a sense of fairness and building a skilled workforce. It's also important to view career development as a central aspect of strategies aimed at employee retention, given its positive impact on performance and job satisfaction. Lastly, organizations should continually evaluate the effectiveness of career development initiatives, making adjustments as necessary to ensure their impact on performance improvement is maximized. Keywords: Career Development, Employee Performance, Personal Growth, Responsibilities, Quality of Services, Task’s Completion, Team Work, Dependability, Reliability and Creativity

ASSESSING KNOWLEDGE, ATTITUDES, AND PRACTICES OF HEALTHCARE PROFESSIONALS REGARDING HOSPITAL ACQUIRED INFECTION IN TERTIARY CARE TEACHING HOSPITAL AT EASTERN NEPAL: CROSS-SECTIONAL STUDY

Hospital-acquired infections (HAIs) are a common problem and represent significant challenges to the effective delivery of healthcare services faced by hospitals in all countries around the world. Healthcare workers (HCWs) are an important part of the healthcare team that plays a unique role in the control of HAIs. Compliance on the part of healthcare workers (HCWs) with standard precautions has been recognized as being an efficient means to prevent and control HAIs. Objective: The present study was conducted with objective of understanding the level of Knowledge, attitude and practice (KAP) regarding Hospital-acquired infections (HAIs) among health care workers in the Eastern region of Nepal. Method:This descriptive cross-sectional study was conducted among healthcare workers posted in different wards of hospitals of BPKIHS. A self administered questionnaire containing different set of questions regarding knowledge, attitude and practice on HAI were used for data collection. Simple random sampling method was employed. Statistical package for social sciences (SPSS) was used to analyze the data and presented in frequency tables and graph. Results: Regarding knowledge of the participants: Among the total participants in the study, 97% of the participants had good knowledge regarding Hospital acquired infections (HAIs) but only 72% of the participants had received formal training regarding hand hygiene. 97 % participants agreed on the fact that hand hygiene act should be performed before and after direct patient contact. Highest proportions of the participants (97%) were aware of the fact that washing hands with antiseptic decreases the risk of transmission of hospital acquired pathogens. Large proportion of the respondents ( 95%) were aware of the fact that Gloves should be worn if blood or body fluid exposure is anticipated and still considered that gloves provided complete protection against acquiring/ transmitting infections. Hand hygiene (89%) and Personal protective equipment 68%) were common preventive measures of transmission of hospital acquired infection. The common sources of acquiring infections was uniform (59%) whereas commonly hospital acquired infection (HAIs) were reproductive tract infection (86%) and gastro -intestinal tract (GIT) infection (76%) and most susceptible group to hospital acquired infections (HAIs) were OT assistants (74%), Lab technicians(69%) etc. Regarding attitude of the participants, 91% of the participants felt that they would be less likely to transmit infection to the patient if they performed hand-hygiene. Regarding various hindrances in adoption of hand hygiene, few of the respondents (48%) identified that hand hygiene agents were not readily available in our current settings. 31% of the health care workers reported that they often forgot to perform hand hygiene.42% of health care workers found that Gloves are always available when they wanted. 25% of health workers believed that there was very low risk of acquiring infections from my patients.79 % participants thought that all patients are potentially contagious while 88% transmission of hospital acquired infections occurred through unsterilized use of needles and sharp objects. Regarding practice of the participants , majority of respondents (more than 90%) performed hand hygiene before patient contact, after patient contact and caring for wound.95% of the participants practiced hand hygiene after removal of gloves. Majority of the participants (97%) washed their hands after handling every patient. 74% participants practiced of using reusable instruments while 86% respondents practiced of using pre-sterilized instruments. 82 % of the participants exposed to patients blood. Conclusion: All health workers had good knowledge regarding Hospital-acquired infections (HAIs) that was reflected in their attitude and practice on hand hygiene for the prevention of HAIs. However there is the need of regular training and performance feedback regarding hand hygiene and the hospital environment should be hand-hygiene friendly with easily accessible to sinks and other facilities. Improving sustainable supplies like personal protective equipment, water supply and hand washing facilities at patient care site is vital to reduce nosocomial infection. Therefore health workers should strictly follow hospital acquired infection prevention guidelines to reduce infections.

Covid-19, Workplace Challenges

Workplace now, workplace then, the new normal is a conceptual paper written to enlightened how organizations monitor employees' work performance from home as versus working in the office as a result of the Covid-19 pandemic. The objective of this article was to determine how organizations are able to measure the performance of their employees when they are working from home. Secondly, to evaluate how organizations are able to monitor virtual workload as versus traditional workload. And finally, through scrutinizing the new workplace normal articles, the author derived the third objective which is to determine how the employees balanced their work and family disputes during the Covid 19 pandemic. Several related articles were scrutinized to demonstrate the current workplace scenario as opposed to the traditional practices. At the end of the article, we proposed monitoring measures and how employees' performance can be improved during the Covid19 pandemic. Flexibility in goal setting, teamwork, and regular performance feedback will psychologically lead to positivity in work performance. Whilst, social support, job autonomy, workload, and monitoring would reduce employees' procrastination in carrying out their virtual workload. And finally, a 360° social support, flexible schedule, mental therapy, and boundary management able to overcome work and mental stress thus create a healthy working environment.

Retrospective validation of Digital Evaluation of Ketosis and Other Diabetes Emergencies (DEKODE) algorithm: automated auditing system for diabetic ketoacidosis (DKA) management

Effective management of diabetic ketoacidosis (DKA) in line with national guidelines improves clinical outcomes and may reduce length of hospital stay.1 Regular auditing and performance feedback are key to achieving sustained and significant improvement in the management of DKA.2,3 One of the major limitations for maximal impact of an audit is the delay from initiation to results as the latter may not be applicable to the then current practice. In order to overcome this, our department of diabetes collaborated with the hospital's health informatics team and created an automated auditing system called Digital Evaluation of Ketosis and Other Diabetes …

Regular performance feedback may be key to maintain good quality DKA management: results from a five-year study

ObjectivesWe postulate that performance feedback is a prerequisite to ensure sustained improvement in diabetic ketoacidosis (DKA) management.DesignThe study was based on ‘theory of change’ concept that suggests changes of primary...

A twelve-year study of the prevalence, risk factors and characteristics of interval colorectal cancers after negative colonoscopy

The objective of our study was to describe and analyse the Post-Colonoscopy Colorectal Cancers (PCCRCs) and endoscopist performance-related risk factors in the Isère regional screening programme. This was a population-based retrospective cohort study between 2002-2013, where Post-Colonoscopy Colorectal Cancers (PCCRCs) were defined as colorectal adenocarcinoma diagnosed between six and sixty months post-colonoscopy following a positive gFOBT. We analysed the endoscopist performance-related risk factors of the 62 gastroenterologists who had carried out at least 30 colonoscopies during this period. During the period reviewed, there were 10,557 negative colonoscopies performed. Fifteen post-colonoscopy colorectal cancers were diagnosed from 2002-2013 with an average patient age of 67.1 years. Men comprised 73% of the cases and 53% of all the cases were found in the distal colon. These 15 cases comprised 1.1% of all Colorectal Cancers (CRCs) diagnosed in the screening programme, with an incidence rate of 0.42 (0.21-0.77) per 1,000 person-years. The aetiological breakdown was as follows: 47% related to missed cancers, 27% were new cancers, 20% were failed biopsy detection, and 6% related to incomplete removal. The Adenoma Detection Rate (ADR) among gastroenterologists was an average of 30%, but large heterogeneity was present within this number, ranging from 11% to 49%. The post-colonoscopy colorectal cancer prevalence and incident rate were low relative to the literature. However, significant heterogeneity was present in the adenoma detection rate. Decreasing this heterogeneity by establishing a national benchmark, regular performance feedback and training modules should homogenise adenoma detection rates and decrease the number of interval cancers in the region.

A Study On Performance Appraisal Techniques In A Selected Industry

Performance appraisal system operates in which an individual manager regularly, annually records performance and developments in top down process. It can be argued that perceived defects of appraisal system led to development of more sound concepts of performance appraisal. The provision of challenging assignments and regular performance feedback are included in effective performance management system. At the end of the performance period usually a year the supervisor and employee meet to summarize the accomplishments and challenges of the past year and document the discussion using performance management form. In any organization to be effective the resources should be property maintained. The study concentrates on finding whether the current performance management system followed in organization is effective and how far they are satisfied and whether all the employees all aware of performance standards fixed for them and promotions are given based on performance. It also suggests whether any change is required in the existing system. Success with performance appraisal system relies on good design and implementation. Managing employee performance is an effective mechanism for developing both employee and organization growth. Management and employee involvement in the design/review of a performance management system is important performance appraisal can be redesigned for betterment of performance. Thus performance appraisal is a shared commitment to high performance.

A Call to Action: Nurse Leader Succession Plan in Acute Care

Nurse leader succession plan in acute care is a business strategy that has a financial impact. Quality care and patient safety is reliant on effective clinical leadership. Efficiency and effectiveness in care delivery processes and outcomes translate into corporate financial sustainability. The premise of nurse leader succession plan is to build leadership capacity for clinicians, and enlarge nursing portfolio. Potential candidates acquire skills and knowledge pertinent to professional growth and leadership roles. Structured mentorship program focus on inter-professional collaboration that enhance clinical and leadership competencies. Individualized professional development plans align competencies with personal career goals. Emerging nurse leaders are inspired to demonstrate commitment and ownership of healthcare processes and outcomes. Regular performance appraisal and feedback provide objectivity in training and development programs. Additionally, communication and relationship management lead to efficiency and mentorship program integration. Succession plan and leadership development advances nursing discipline, autonomy, career development and job satisfaction. Therefore, a nurse leader succession plan provides a reflection on the voice of a nurse in hospital environment.

Structured Feedback: Acceptability and Feasibility of a Strategy to Enhance the Role of a Clinical Quality Registry to Drive Change in Cardiac Surgical Practice

The Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) Database collects and monitors preoperative, operative, and 30-day outcome data on patients undergoing cardiac surgery, and delivers regular performance feedback reports to key personnel with intent to drive quality improvement. The current feedback approach appears to be ineffective in driving change to minimise Unit performance variation. We sought to determine the acceptability and feasibility of providing structured feedback in addition. Cardiac surgeons were surveyed to assess their evaluation of the current feedback reports and assist in developing the content of structured feedback. We then assessed acceptability and performance outcomes of control Units receiving current feedback reports via email, versus intervention Units that in addition received structured feedback. Survey respondents assessing the current feedback report agreed that the content is relevant (95%), key performance indicators (KPIs) are useful (85%), and that it would be beneficial to compare surgeons' KPIs (75%). Survey respondents rating method of feedback, requested structured feedback sessions one to two times annually (67%; control Units), and future structured feedback (83%; intervention Units). With combined report and structured feedback, improved performance was noted for an under-performing Unit. Limitations of feedback in driving quality improvement was high performance of Units at baseline, low surgeon participation, and scheduling challenges for structured feedback. In this pilot study, compared to the control method, structured feedback did not significantly improve communication. To maximise quality improvement efforts, a collaborative feedback approach that fosters a climate of continuous performance improvement, is recommended.

A physician targeted intervention improves prescribing in chronic heart failure in general medical units

BackgroundDespite strong evidence for beta-blockers and angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) in chronic heart failure (CHF), they have been under-utilised especially in general medical units. We aim to evaluate the effectiveness and feasibility of a physician-targeted quality improvement intervention with education and feedback on the prescription of beta-blockers and ACEI/ARB for CHF management in an inpatient setting.MethodsWe conducted an interrupted time series study between January 2009 and February 2012. A two-stage intervention was implemented. Between November 2009 and January 2011, a structured physician-oriented education program was undertaken. From February 2011, quarterly performance feedback was provided to each medical unit by a senior clinician. Medical notes of patients admitted with CHF under general medical units before and during the intervention were prospectively audited. Main outcomes were beta-blockers and ACEI/ARB prescription rates, and 180-day readmission rates for CHF.ResultsFour hundred and sixty-eight patients were included in this study. Structured education program was associated with a significant rise in beta-blockers prescription rates from a baseline of 60 to 92% (p = 0.003), but a non-sustained rise in ACEI/ARB prescription. Regular performance feedback resulted in a further sustained increase in ACEI/ARB prescription rates from 62 to 93% (p = 0.028) and a positive trend for beta-blockers with rates maintained at 89%. There was a reduction in 180-day readmission rates that correlated with the improvements in beta-blocker (p = 0.030) and ACEI/ARB (p = 0.035) prescription.ConclusionImplementation of a structured education program with regular performance feedback was durable and was associated with improvements in appropriate prescribing and an observed decrease in CHF-related readmissions.

The Effects of Practice-Based Training on Graduate Teaching Assistants' Classroom Practices.

Evidence-based teaching is a highly complex skill, requiring repeated cycles of deliberate practice and feedback to master. Despite existing well-characterized frameworks for practice-based training in K-12 teacher education, the major principles of these frameworks have not yet been transferred to instructor development in higher educational contexts, including training of graduate teaching assistants (GTAs). We sought to determine whether a practice-based training program could help GTAs learn and use evidence-based teaching methods in their classrooms. We implemented a weekly training program for introductory biology GTAs that included structured drills of techniques selected to enhance student practice, logic development, and accountability and reduce apprehension. These elements were selected based on their previous characterization as dimensions of active learning. GTAs received regular performance feedback based on classroom observations. To quantify use of target techniques and levels of student participation, we collected and coded 160 h of video footage. We investigated the relationship between frequency of GTA implementation of target techniques and student exam scores; however, we observed no significant relationship. Although GTAs adopted and used many of the target techniques with high frequency, techniques that enforced student participation were not stably adopted, and their use was unresponsive to formal feedback. We also found that techniques discussed in training, but not practiced, were not used at quantifiable frequencies, further supporting the importance of practice-based training for influencing instructional practices.

Increasing Teachers’ Use of Behavior-Specific Praise Using a Multitiered System for Professional Development

Successful instruction is contingent upon effective classroom management. Unfortunately, not all teachers are effective classroom managers and many require in-service professional development (PD) to increase their use of evidence-based classroom management skills. Although PD models have been developed and evaluated, many are resource-intensive. To address this, we developed a multitiered system for PD (MTS-PD) to provide increased levels of support based on need as measured by teacher behavior. We conducted two studies to examine the effect of Tiers 1 and 2 of the MTS-PD model on elementary school teachers’ use of behavior-specific praise (BSP). Study 1 examined the effect of Tier 1, a single 25-min didactic training, and Study 2 examined the effect of Tier 2, which included regular visual performance feedback delivered via email. The results of Study 1 indicated that teachers did not increase their rates of BSP to a priori defined levels of success. Study 2 found that the Tier 2 PD approach increased teachers’ BSP rates, a functional relationship was established, and the rates maintained 3 months after the Tier 2 PD. Study limitations and future directions are discussed.

Disruptive behaviour in the perioperative setting: a contemporary review

PurposeDisruptive behaviour, which we define as behaviour that does not show others an adequate level of respect and causes victims or witnesses to feel threatened, is a concern in the operating room. This review summarizes the current literature on disruptive behaviour as it applies to the perioperative domain.SourceSearches of MEDLINE®, Scopus™, and Google books identified articles and monographs of interest, with backreferencing used as a supplemental strategy.Principal findingsMuch of the data comes from studies outside the operating room and has significant methodological limitations. Disruptive behaviour has intrapersonal, interpersonal, and organizational causes. While fewer than 10% of clinicians display disruptive behaviour, up to 98% of clinicians report witnessing disruptive behaviour in the last year, 70% report being treated with incivility, and 36% report being bullied. This type of conduct can have many negative ramifications for clinicians, students, and institutions. Although the evidence regarding patient outcomes is primarily based on clinician perceptions, anecdotes, and expert opinion, this evidence supports the contention of an increase in morbidity and mortality. The plausible mechanism for this increase is social undermining of teamwork, communication, clinical decision-making, and technical performance. The behavioural responses of those who are exposed to such conduct can positively or adversely moderate the consequences of disruptive behaviour. All operating room professions are involved, with the rank order (from high to low) being surgeons, nurses, anesthesiologists, and “others”. The optimal approaches to the prevention and management of disruptive behaviour are uncertain, but they include preventative and professional development courses, training in soft skills and teamwork, institutional efforts to optimize the workplace, clinician contracts outlining the clinician’s (and institution’s) responsibilities, institutional policies that are monitored and enforced, regular performance feedback, and clinician coaching/remediation as required.ConclusionsDisruptive behaviour remains a part of operating room culture, with many associated deleterious effects. There is a widely accepted view that disruptive behaviour can lead to increased patient morbidity and mortality. This is mechanistically plausible, but more rigorous studies are required to confirm the effects and estimate their magnitude. An important measure that individual clinicians can take is to monitor and control their own behaviour, including their responses to disruptive behaviour.

Knowledge, Attitude and Practice of nursing students on Hospital Acquired Infections in Western region of Nepal

Background & Objectives: Hospital-acquired infections (HAIs) are a common problem and challenge faced by hospitals in all countries around the world. Nurses are an important part of the healthcare team that plays a unique role in the control of HAIs. Compliance on the part of healthcare workers (HCWs) including nurses with standard precautions has been recognized as being an efficient means to prevent and control HAIs. The present study was conducted with objective of understanding the level of Knowledge, attitude and practice (KAP) regarding HAIs among nursing students in the Western Region of Nepal.Materials & Methods: This descriptive cross-sectional study was conducted among nursing students posted in different wards of two hospitals of Pokhara. A self administered questionnaire containing different set of questions regarding knowledge, attitude and practice on HAI were used for data collection.Results: Among the total participants in the study 97% of the participants considered that prevention of HAIs were a valuable part of nurses’ role but only 89% had received formal training regarding hand hygiene. The results show that 74% of the participants had good knowledge regarding HAIs. 82% of the participants felt that they would be less likely to transmit infection to the patient if they performed hand-hygiene. 66% of them identified that hand hygiene agents were not readily available in current settings. Regarding practice, only 6% performed hand hygiene before patient contact.Conclusion: The nursing students had good knowledge regarding HAIs that was reflected in their attitude and practice on hand hygiene for the prevention of HAIs. However there is the need of regular training and performance feedback regarding hand hygiene and the hospital environment should be hand-hygiene friendly with easily accessible to sinks and other facilities.

An empirical examination of the relationship between adult attention deficit and the operational effectiveness of project managers

Purpose – The purpose of this paper is to examine the relationship between adult attention deficit (AAD) and the operational effectiveness of project managers (OEPM). Design/methodology/approach – In total, 160 actively employed business graduate students participated in a business course where they were assigned to four person project teams responsible for completing a major business project. The project contained four sub-projects each of which was managed by a different team member. At the end of the semester each team member rated the others on their operational effectiveness as a project manager. Each subject identified a close associate who completed an observer version of the Brown Attention Deficit Scale. Product moment correlations were used to test the hypotheses that AAD and each of the symptom clusters are negatively associated with OEPM. Simultaneous linear regression was used to test the hypothesis that difficulties activating and organizing to work (DAOW) is uniquely associated with OEPM after controlling for the influence of all the other symptom clusters. Findings – AAD and each of the symptom clusters is negatively associated with OEPM, and DAOW is uniquely associated with OEPM. Research limitations/implications – Research study is limited by use of an indirect work sample (working graduate students) and future research requires direct workplace samples of project managers. The influence of creativity within the relationship between AAD and project management effectiveness requires further investigation and may reveal beneficial aspects of the disorder. Practical implications – Individuals and organizations wanting to ensure timely and successful completion of key tasks and projects need to be aware of the influence of AAD on OEPM. The provision of intensive project management training/coaching, regular performance feedback, project management tools and an organized work space free of distractions is suggested for disordered project managers. Disordered project managers are especially vulnerable during the task activation and organization phase which may be addressed through the use of peer coaching and constructive team support. The effective design and management of project teams represents a significant opportunity for distributing the potential creative benefits of the disorder while managing the deficits. Pairing disordered employees with coworkers who are less creative but have better administrative skills may be mutually beneficial. Employee assistance programs that raise awareness and provide access to assessment are an important part of multimodal management of the disorder. Social implications – Increasing social, economic and legal pressures to provide reasonable accommodation for functional but disordered employees, be more inclusive and take appropriate advantage of employee diversity underscores the general social value of this research. Originality/value – This research study is the first examination of the influence of AAD within the nomological network that determines project manager effectiveness. The results are of value to researchers, organizational development specialists, human resource management specialists, managers and employees who are seeking effective multimodal management of the disorder in the workplace.

Automated Charting and Systems Integration: For Patients’ Safety and Our Sanity

Automated Charting and Systems Integration: For Patients’ Safety and Our Sanity

SBIRT Implementation for Adolescents in Urban Federally Qualified Health Centers

BackgroundAlcohol, tobacco, and other drug use remains highly prevalent among US adolescents and is a threat to their well-being and to the public health. Evidence from clinical trials and meta-analyses supports the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) for adolescents with substance misuse but primary care providers have been slow to adopt this evidence-based approach. The purpose of this paper is to describe the theoretically informed methodology of an on-going implementation study. MethodsThis study protocol is a multi-site, cluster randomized trial (N=7) guided by Proctor’s conceptual model of implementation research and comparing two principal approaches to SBIRT delivery within adolescent medicine: Generalist vs. Specialist. In the Generalist Approach, the primary care provider delivers brief intervention (BI) for substance misuse. In the Specialist Approach, BIs are delivered by behavioral health counselors. The study will also examine the effectiveness of integrating HIV risk screening within an SBIRT model. Implementation Strategies employed include: integrated team development of the service delivery model, modifications to the electronic medical record, regular performance feedback and supervision. Implementation outcomes, include: Acceptability, Appropriateness, Adoption, Feasibility, Fidelity, Costs/Cost-Effectiveness, Penetration, and Sustainability. DiscussionThe study will fill a major gap in scientific knowledge regarding the best SBIRT implementation strategy at a time when SBIRT is poised to be brought to scale under health care reform. It will also provide novel data to inform the expansion of the SBIRT model to address HIV risk behaviors among adolescents. Finally, the study will generate important cost data that offer guidance to policymakers and clinic directors about the adoption of SBIRT in adolescent health care.

Training New Instructors to Implement Discrete Trial Teaching Strategies With Children With Autism in a Community-Based Intervention Program

The effects of training and supervision on instructor knowledge and performance of discrete trial teaching (DTT) within three domains (DTT Technical Skills; Work Session Preparation/Conclusion; and Student Engagement/Management) were examined in this study. Eight undergraduate student instructors received an 8-hr training in DTT and support skills accompanied by a pre- and post-test of knowledge. The instructors then taught a variety of skills to six students with autism in a community-based preschool, where instructor competence was tracked and performance feedback provided using the Discrete Trial Teaching Competency Checklist for Instructors. Competence in all three domains improved over time with performance feedback. However, significant variability was observed within and between instructors, and performance in some areas remained below optimal levels even with regular supervision and performance feedback. Implications for training and supervising instructors to implement DTT with children with autism in community-based settings are discussed.