AN EXAMINATION OF THE EFFECTS OF FEEDBACK AND ACCEPTANCE AND COMMITMENT TRAINING ON DIRECT SUPPORT PROFESSIONAL ACTIVE TREATMENT IMPLEMENTATION, STRESS, AND JOB SATISFACTION

Author

John Charles Pingo, Southern Illinois University CarbondaleFollow

Date of Award

12-1-2010

Degree Name

Doctor of Philosophy

Department

Rehabilitation

First Advisor

Dixon, Mark

Abstract

Relational Frame Theory (RFT; Hayes, Barnes-Holmes, and Roche, 2001) describes verbal contingencies as networks of relations between overt and covert stimuli. RFT posits that the ability to form these relational networks is a key component of language and cognition. These relations can become problematic when they result in an individual rigidly responding to verbal contingencies even when environmental contingencies produce more adaptive outcomes. RFT has given rise to an intervention program called Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999) that is designed to help people see past maladaptive verbal contingencies. ACT's utility in the area of OBM is still in the early stages of exploration. Experiment 1 examined the effect of a verbal and written performance feedback system with a low cost probabilistic contingency reward program and an eight hour ACT training program on the percentage of time Direct Support Professionals (DSPs) spent engaged in active treatment and the technical competence of active treatment provided to people with disabilities. The experiment used a pretest/posttest design with a waitlist control group and two intervention groups. DSPs serving children and adults with developmental disabilities in a residential and small group home settings participated in the experiment. The first intervention group received only the feedback intervention while the second intervention group received the feedback intervention and the ACT training. After attrition the group sizes were control N = 12, feedback only N = 12, and feedback plus ACT N = 17. Both intervention groups performed significantly better than the control group. The feedback plus ACT group outperformed the feedback only group by 27.8% in percentage of observation time engaged in active treatment at posttest. The result was statistically significantly at the .05 level of significance. The feedback plus ACT group also exhibited superior but nonsignificant improvements over the feedback only group in the areas of competency of operant teaching techniques (14.9%), percentage of clients engaged in purposeful activities (10.7%), and percentage of clients with learning or leisure materials within arm's reach (11.0%). Regression analyses found a weak positive correlation between age and frequency of active treatment (R2 = .11, F(1, 39) = 4.99, p < .05), a weak positive correlation between psychological flexibility as measured by the Acceptance and Action Questionnaire-2 (AAQ-2) and job satisfaction, a weak negative correlation between psychological flexibility and self-reported workplace stress, and a weak negative correlation between stress and job satisfaction. Self-reported levels of psychological flexibility, workplace stress, and job satisfaction remained stable for all three groups from pre to posttest despite the increased performance expectations on DSPs in the two intervention groups. Possible explanations for the differences in performance are discussed. Experiment 2 consisted of a small scale replication of the active treatment findings of experiment 1 while examining what impact, if any, higher frequency observations and verbal and written feedback would have on DSP self-reported workplace stress, job satisfaction, and psychological flexibility. Experiment 2 also used participants 25 years of age and under to further explore and possibly rule out the age-active treatment correlation found in experiment 1 as a significant variable impacting the frequency of active treatment. The intervention procedures used in experiment one were adapted for experiment two. The specific intervention components used were verbal performance feedback and a one-on-one daylong version of the eight-hour ACT training program used in experiment one. Two separate multiple baseline designs across participants were used. Group one consisted of three DSPs and group two contained 2 DSPs. The feedback intervention produced improvements in the percentage of time DSPs were engaged in active treatment during observations and in their operant teaching skills competency-based testing assessment scores. Three DSPs failed to meet the performance target after the feedback intervention was introduced but met or exceeded the performance target after the daylong ACT training was implemented.