Project Description:
The purpose of the proposed study is to determine if restraints, seclusions, and isolation are reduced after increased training and support are provided to staff already implementing TCI at an agency with day treatment/school programs and residential treatment settings. Furthermore, researchers will examine the effects of increased support on staff injury, workers compensation claims, staff turnover, and staff job satisfaction. The agency where this study is to be executed has been using TCI and has received support in its use from a team at Cornell University, where TCI was developed.
This research will provide data on the effectiveness of the comprehensive crisis intervention approach, TCI, plus supplemental assessment, training, and support in the use of TCI. Results of this research may be useful to similar programs seeking to reduce the use of restraint, seclusion, and isolation.
Methods: The research will be conducted at two of the providers sites, both of which have day treatment/school settings and several residential treatment programs. An intervention, consisting of a comprehensive assessment and increased support from the Cornell University team for TCI, will be implemented in residential treatment settings (excluding the providers childrens residential treatment setting) and the school setting at one site. The intervention will not be implemented at the school and residential treatment settings at the other site, which will serve as a control group. The name of the intervention is the Quality Improvement and Fidelity Assessment Process (QIFAP).
The Cornell team is conducting research and evaluation under a protocol approved by a Cornell IRB. The research proposed under the current proposal to the UMaine IRB does not duplicate the Cornell research, but it will collect information from the site on any changes in practice or provision of enhanced support (and the times that such changes or enhanced support were implemented) in order to assess the extent to which any changes in the present studys outcome variables are associated with such changes in practice or enhanced support.
At least three months of baseline data at both sites will be reported by the provider to the University of Maine research project staff. The information collected will include the (1) total number of restraints, seclusions, and isolations at each site, (2) restraint techniques used in each case of restraint, (3) the duration of each case of restraint, isolation, or seclusion, (4) times and dates of each restraint, isolation, and seclusion, and (5) copies of incident reports for each incident of restraint, isolation, and seclusion with students for whom we have obtained both student assent and parent or guardian consent. The provider will replace names of the students in these reports with a numerical code. In addition, the provider will report monthly data on the number of workers compensation claims, time lost to injury, and staff retention at each site.
Researchers will administer the Brayfield-Rothe Job Satisfaction Index (Brayfield & Rothe, 1951) to provider staff at both sites to measure their job satisfaction. (See Appendix C). This instrument is a short, well-established measure of job satisfaction that can be used to provide an overall score of job satisfaction. It has high levels of reliability and validity and has been used by a number of researchers to measure job satisfaction among special educators (Darcy, Kuszinikow, & Lester, 1995; McCarty, 2013; Stempien & Loeb, 2002, Viel-Ruma, Jolivette, & Benson, 2010). Staff will be asked to complete the initial employee satisfaction survey online within a week of signing the consent forms. Staff will be asked to complete the second and third surveys online, using Qualtrics, 9 months and 18 months after the intervention has begun.
Following the recommendations by the Cornell team, and the initiation of the QIFAP, the provider will continue to report all data recorded in the baseline, except for the job satisfaction surveys, on a monthly basis to the University of Maines CCIDS project staff. The job satisfaction surveys will be re-administered nine months and 18 months after the intervention has been initiated. In addition, once a month CCIDS researchers will interview provider staff who were involved in recent randomly selected, documented incidents of restraint, seclusion, or isolation. One incident at a residence and one at a day treatment program, in both the control and intervention locations, (4 incidents total) will be selected to review each month. Up to four staff for each incident will be interviewed individually. These interviews will occur in person or by phone or teleconference with individual staff. CCIDS project staff will use a short structured interview as a reliability measure to determine the extent to which participating staff agree with each other and with the incident report in their descriptions of the incident including the time, whether restraint, seclusion, or isolation was used, the restraint technique used, the duration of the restraint, the number of people involved, and the factors that may have led up to the behavior (antecedents). For those items where staff answer open-ended questions about the incident, at least two of the researchers will review the answers and come to a consensus about whether the respondents are in agreement. (See Appendix C for the interview form.)
Provider administrators will send data on staff turnover for the residences and the day treatment programs in each location to the researchers every six months. Project staff will meet with administrators at least every other month to review changes in the QIFAP intervention. Any assessment activities, additional supports provided by the Cornell team, changes to the overall TCI program, and the dates when those assessments were conducted or changes implemented will be documented and summarized.
The researchers will analyze the data to determine if there are significant changes over time in the use of seclusion, the frequency and duration of restraints, the restraint techniques used, and the frequency and duration of isolation. The fidelity of the incident reports will be determined by comparing the data from the incident reports with staff interview data. This data will be analyzed at both an aggregate level and an individual student and staff person level. Researchers will also determine whether there are significant changes over time in time lost to injury, workers compensation claims, and job satisfaction at an aggregate and individual staff person level. Staff turnover data will be analyzed to determine if there are significant differences between the intervention and control sites regarding staff turnover rates.
