Maintaining instructional performance with feedback in habilitative programs

In habilitative programs for persons with intellectual or psychiatric disabilities, direct-care providers, such as nursing assistants, therapy assistants, parents, and many others, play a crucial role in instructing and maintaining a wide range of daily living skills including communication, vocational, leisure, and self-care. Indeed, the success of habilitative programs is largely dependent on how effectively direct-care providers instruct their clients. To this end, most habilitative programs offer direct-care providers--or more precisely, instructors--inservice training in the basics of instruction. Training is usually more effective when instructors receive on-the-job feedback, but once training ceases, continuing with feedback to maintain instructor performance can be intrusive and costly in time and effort. Typically, feedback during maintenance has emphasized instructor performance (i.e., process) via instructors self-recording their performance, or via frequent recordings from supervisory agents. However, these procedures are not only costly to maintain, but the research has remained inconclusive about their usefulness. Furthermore, these feedback procedures could hinder transfer of control of instructor performance to more natural contingencies. Alternatively, maintenance can be approached by transferring control to more natural contingencies utilizing positive changes in client behaviour (i.e., feedback emphasizing outcome). The aim of this thesis was to investigate more efficient feedback for maintaining instructor performance. Five studies are reported in which instructors and clients with intellectual disabilities participated in instructional programs in leisure, preacademic, and communication skills, in settings including a group home, family home, school, and nursing home. The instructors, who varied in instructional expertise and experience, ranged from paid staff to unpaid students and other volunteers. Intrasubject research designs were used with repeated measures of (a) occurrence and performance error percentages of instructors' verbal instructions, prompts, and consequences, (b) performance fluency (i.e., correct trials per minute), and (c) client behaviour. Instructor training included written descriptions and guidelines, discussion, and modelling of instructional performance, but the predominant procedures were on-the-job verbal feedback on correct performance of verbal instructions, prompts, and consequences, and instructors' recording and graphing unprompted correct client behaviour. Training continued until performance mastery was achieved. Maintenance was tested while instructors continued with their recording and graphing of client behaviour, but without feedback on instructor performance (i.e., outcome feedback alone). Also, effects of instructors' rating their own performance, and effects of increasing performance fluency were assessed. The results show that instructors maintained mastery-level performance and correct client behaviour for up to 13 weeks with the recording and graphing of positive changes in client behaviour, that is, with feedback from client behaviour alone. Instructors' self-ratings, and increases in performance fluency did not enhance maintenance. These results significantly extend current research in two ways. First, instructors' recording of client behaviour alone was sufficient for maintenance, and that instructors' self-recording or frequent supervisory feedback were unnecessary. Second, by measuring instructor performance in terms of occurrence, performance error, and fluency during training and maintenance conditions, a more comprehensive and precise description of performance mastery was obtained. A new graphic depiction of performance was tested and proved useful, particularly when performance was variable. The research supports the conclusion that durable instructional performance in habilitative programs requires (a) effective client behaviour change programs, (b) instructors trained to mastery with on-the-job feedback that emphasizes instructor performance including recording of client behaviour, and (c) after training, continuation of feedback via instructors' recording and graphing of client behaviour, with occasional independent observations