There are many types of programs that providers are expected to implement with fidelity. This includes the areas of clinical and professional skills, as well as determining if environmental barriers are impacting fidelity. During supervisory observations, fidelity data should be collected on each of the various skill domains that the supervisor would like to measure. This installment discusses areas for supervisors to consider.
Clinical skills
Clinical skills refer to the “hard skills” that providers are expected to perform, such as implementing a skill acquisition protocol. These are often the skills that are taught during initial and ongoing training. Providers are expected to have the knowledge and ability to implement a wide variety of procedures. This may include behavior reduction plans, skill acquisition programming, and preference assessments, among others. All of these areas should be targeted by supervisors when observations are conducted.
Professional skills
Professional skills refer to the “soft skills” that providers are expected to exude, such as interacting appropriately with clients, caregivers, colleagues, and supervisors. Professional skills span building rapport with clients and caregivers to receiving and providing feedback to colleagues and supervisors. Other professional skills include following safety protocols, behaving in accordance with the ethical code, and dressing appropriately.
Unfortunately, these skills are not often targeted for improvement with providers. So much of the work they do involves engaging in professional behavior. Therefore, supervisors must collect fidelity data on these behaviors. Here are some recent articles that have begun to determine effective ways to teach these more complex, soft skills: Erlich et al., 2020; Shuler & Carroll, 2019; Walker & Sellers, 2021.
Environmental Barriers
Environmental barriers refer to anything in the environment that may be interfering with one's ability to implement a protocol to expectation, such as having the required materials for the session. It is not enough to just focus on the clinical and professional skills of providers. Supervisors must also be cognizant of what is happening in the environment that could be affecting fidelity. This includes the immediate clinical environment, as well as the broader context for the provider.
Related to the immediate clinical environment, some questions supervisors can ask themselves include: Does the provider have the materials necessary for programming? Are reinforcers readily available? Are the gloves within reach?
As humans, we are all dealing with a multitude of experiences and troubles. Supervisors should work with their providers to determine whether they can support them in any way. Without having the data to determine if there is a pattern of behavior, it may be difficult to offer support. Once a pattern of behavior is revealed, supervisors should refrain from engaging in organizational victim blaming (e.g., the provider regularly shows up 10 minutes late to shift. If a supervisor were to engage in organizational victim blaming then they may think that the provider does not care or that they are lazy).Whatever comes to mind is likely not the case. There are other reasons to explain that behavior. As behavior analysts, we need to take a functional approach. To do so, we need data on what environmental barriers may be impacting the quality of services provided. Have conversations with your providers about how you can make their work easier!
References:
Ehrlich, R. J., Nosik, M. R., Carr, J. E., & Wine, B. (2020). Teaching employees how to receive feedback: A preliminary investigation. Journal of Organizational Behavior Management, 40(1-2), 19-29. https://doi.org/10.1080/01608061.2020.1746470
Shuler, N., & Carroll, R. A. (2019). Training supervisors to provide performance feedback using video modeling with voiceover instructions. Behavior Analysis in Practice, 12(3), 576-591. https://doi.org/10.1007/s40617-018-00314-5
Walker, S., & Sellers, T. (2021). Teaching appropriate feedback reception skills using computer-based instruction: A systematic replication. Journal of Organizational Behavior Management, 41(3), 236-254. https://doi.org/10.1080/01608061.2021.1903647
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