Benefits and qualities of groups in human services

B R I E F R E P O R T

Social validity assessment of behavior data recording among human services care providers

Joseph N. Ricciardi1 | Allison Weiss Rothschild2 |

Natalie M. Driscoll2 | Jillian Crawley2 | Joshua Wanganga2 |

David A. Fofanah2 | James K. Luiselli3

1Seven Hills NeuroCare, Worcester, MA, USA

2Seven Hills Community Services, Middleton,

MA, USA

3Melmark New England, Andover,

Massachusetts, USA

Correspondence

Joseph N. Ricciardi, PsyD,ABPP, BCBA-D,

CBISTAssistantVice President/Director of

Clinical Services, Seven Hills NeuroCare, 81

Hope Avenue, Worcester, MA 01603

Email:[email protected]

Care providers within human services organizations have

many job responsibilities and performance expectations. In

the present study, we conducted social validity assessment

with 78 care providers concerning their attitudes and opin-

ions about behavior data recording with adults who had

intellectual disability and lived in community group homes.

Specifically, the care providers responded to a written ques-

tionnaire that inquired about the practicality, training/

supervision, and value of behavior data recording in the

context of service delivery. Results indicated generally high

approval of behavior data recording practices, purposes,

and approaches to training. We discuss implications of

these findings for implementing data recording by care pro-

viders and the contribution of social validity assessment to

training and performance management within human ser-

vices organizations.

K E Y W O R D S

behavior data recording, care provider training, human services

organizations, performance management, social validity

1 | INTRODUCTION

Training and performance management of care providers are critical objectives within human services organizations

serving persons who have intellectual disability (ID) (DiGennaro Reed, Hirst, & Howard, 2013; Lerman, LeBlanc, &

Valentino, 2015; Luiselli, 2018). Effective training and performance management produces a more competent work-

force which leads to improved outcomes for service recipients, higher job satisfaction, reduced turnover, and profes-

sional growth (Britton Laws, Kolomer, & Gallagher, 2014; Ejaz, Noelker, & Menne, 2008; Firman, Orient, Steiner, &

Received: 16 March 2020 Revised: 12 June 2020 Accepted: 15 June 2020

DOI: 10.1002/bin.1730

458 © 2020 John Wiley & Sons, Ltd Behavioral Interventions. 2020;35:458–466.wileyonlinelibrary.com/journal/bin

Firmin, 2013). Notably, several approaches to training and performance management within applied behavior analy-

sis (ABA) and organizational behavior management (OBM) have good evidence support such as behavioral skills

training (BST), pyramidal training, and performance feedback (Arco, 2008; LeBlanc, Gravina, & Carr, 2009; Parsons,

Rollyson, & Reid, 2012; Shapiro & Kazemi, 2017).

Social validity is a facet of care provider training and performance management concerned with acceptance and

approval of objectives, methods, and outcomes (Gravina et al., 2018; Luiselli, 2020; Schwartz & Baer, 1991;

Wolf, 1978). Typically, social validity is assessed through questionnaires and surveys that elicit care provider atti-

tudes and opinions about the types of training and performance management they received (Gravina & Austin, 2018;

Luiselli, Bass, & Whitcomb, 2010; Miller, Carlson, & Sigurdsson, 2014), procedural preferences (Reed, DiGennaro

Reed, Campisano, Lacourse, & Azulay, 2012), and motivational incentives (Wine, Reis, & Hantula, 2014). Through

social validity assessment, human services organizations are able to align the perceptions of care providers with val-

ued operations, identify common themes that impact programming, and consider alternative systems-wide practices.

Among many responsibilities, care providers are frequently required to record data in order to objectively mea-

sure the effects of service delivery with persons who have ID (Mayer & DiGennaro Reed, 2013; Rehfeldt, Baker, &

Grannan, 2014). For example, data recording by care providers has targeted how often service-recipients complete

care routines (Burg, Reid, & Lattimore, 1979), initiate and respond to social interactions (Doerner, Miltenberger, &

Bakken, 1989), and demonstrate challenging behavior (Flood & Luiselli, 2012). However, training and performance

management of care provider data recording has infrequently assessed social validity. In illustration, Gerald, Keeler,

Mackey, Merrill, and Luiselli (2019) evaluated the effects of a self-management intervention on behavior data record-

ing by educational care providers followed by social validity assessment of how the intervention was conducted, the

skills acquired through intervention, and recommendation of the intervention to other staff. Similarly, Mishra, Grasso,

Essien, and Luiselli (2019) had educational care providers rate their preference for environmental cuing and perfor-

mance monitoring interventions to improve data recording of activity completion by students. Given the emphasis

many human services programs place on objective measurement, social validity assessment of data recording should

be more fully integrated within training and performance management as well as other operations that apply to care

providers (Ferguson et al., 2018; Gravina et al., 2018).

The present paper reports a social validity assessment study with human services organization care providers to

identify their attitudes and opinions about behavior data recording they were required to complete with adults who

had ID. We describe development of a social validity questionnaire, summarize care provider responses, and discuss

implications of the findings for conducting training and performance management. The study illustrates how human

services organizations can adopt social validity assessment as an approach to evaluate and improve operations

through collaborative teamwork with and recommendations from employees (Laffel & Blumenthal, 1989).

2 | METHOD

2.1 | Participants and setting

The participants were 78 care providers (61% female, 39% male) who were employed at a human services organiza-

tion for adults with ID. The average age of the participants was 40.6 years (SD = 11.6 years) with an average of

9.5 years (SD = 7.3 years) working in the field of intellectual and developmental disabilities. With regard to level of

education, the participants had a high school or general education diploma (34.7%), associate degree (27.8%), under-

graduate college degree (27.8%), and graduate school degree (9.7%).

The participants were assigned to 13 community group homes that served a total of 48 adults with ID (22–

80 years old). Between two to five adults lived in each group home and received habilitation services 24 hours per

day 7 days per week. In their roles as care providers, the participants generally worked 8-hr daily shifts in the group

homes, 40 hours per week, and occasionally overtime hours when additional shifts were available. Participants

RICCIARDI ET AL. 459

conducted many activities with the adults, including but not limited to teaching adaptive living, self-care, communica-

tion, and leisure skills, arranging community events, dispensing approved medications, planning group home sched-

ules, and coordinating visits with families.

All of participants consented to the study following meetings with the authors at which time they were informed

about a project to sample their “opinions and feedback about recording behavior data.” They were told further that

the project entailed completing a brief questionnaire, was voluntary, did not represent a performance appraisal, and

would not affect their current and future employment. None of the participants declined the request to complete

the questionnaire.

2.2 | Data recording responsibilities

Approximately 48% of the adults living in the group homes had written procedural guidelines or intervention plans

that addressed challenging behavior such as aggression, self-injury, property destruction, environmental disruption,

and non-compliance. During their assigned shifts, the participants were required to record several types of behavior

data associated with these guidelines and plans. The behavior data were recorded as frequency counts or occurrence

intervals on adult-specific forms contained in program binders at the group homes. These were paper-and-pencil

forms that also specified the timeframes for data recording (e.g., end of a shift).

The participants had been trained to record behavior data immediately following their assignment to a group

home. Training conducted by an assigned clinician generally consisted of explaining behavior data recording respon-

sibilities, the format of recording forms, and behavior definitions specific to each adult. Clinicians also used instruc-

tions, demonstration, and performance specification during training interactions. Participants were able to pose

questions during training and subsequently affirmed their comprehension of expectations and procedures by signing

a confirmation document. Following initial training, clinicians continued to consult with participants during scheduled

meetings and observations that addressed behavior data recording guidelines.

2.3 | Questionnaire construction and distribution

The authors formed a research team at the human services organization comprised of clinicians, behavior analysts,

and group home supervisors who designed, distributed, and evaluated results from the social validity assessment

questionnaire. The questionnaire had three categories pertaining to (a) practicality/ease of use, (b) training/supervi-

sion, and (c) importance/usefulness of behavior data recording required of the participants as care providers in the

group homes. Each category included six statements that were judged to be most relevant to the objectives of social

validity assessment (Table 1). Twelve of the 18 statements (six statements per category) were worded positively such

as, “I know when I am responsible for recording behavior data,” and six of the 12 statements (two statements per

category) were reverse coded in the form, “I have not been trained to complete behavior data recording sheets in

the program.” For each statement on the questionnaire, participants endorsed one numerical rating on a 5-point

Likert scale (1: strongly disagree, 2: disagree, 3: neither disagree or agree, 4: agree, 5: strongly disagree).

Clinicians who were members of the research team distributed a hardcopy of the questionnaire to the partici-

pants during a meeting at their respective group homes. While following a standardized script, the clinician con-

ducting the meeting reminded the participants about the purpose of the questionnaire and asked that they first fill-in

the demographic information requested on the first page (age, sex, educational background, years of experience).

Next, the clinician explained that there were 18 statements on the questionnaire and the participants should check

one of the five numerical ratings for each statement. The clinician answered any inquiries from the participants, then

distributed the questionnaire while remaining present during the time required for completion. The participants

responded to the questionnaire independently and anonymously without conferring with each other, handing it to

460 RICCIARDI ET AL.

TABLE 1 Social validity questionnaire categories and statements

Category Statement

Practicality/Ease of use The behavior recording data sheets are easily accessible

There is enough time to record behavior data while on shift

Behavioral definitions are easy to understand

My other job tasks get in the way of recording behavior dataa

I know when I am responsible for collecting behavior data

Behavior recording data sheets are not easy to fill outa

Training/Supervision I have not been trained to complete behavior data recording sheets in the programa

Additional training in behavior data recording would be helpful

Other staff and I record behavior data the same way

My supervisor teaches me how to complete behavior data recording sheets

I do not have someone to contact if I need clarification completing data recording sheetsa

Training in behavior data recording has happened on my shift

Importance/Usefulness Behavior data are important for my work

I do not find it helpful to review behavior data periodicallya

I understand how clinicians use behavior data after it has been recorded

Behavior data I record are used to make decisions about the people I serve

I have been shown graphs of the behavior data I record in the program

Recording behavior data does not help the people I servea

aIndicates reverse coding.

TABLE 2 Rank ordered ratings on social validity questionnaire

Questionnaire statement Average rating

I know when I am responsible for recording behavior data 4.66 (SD = 0.75)

Behavior data I record are used to make decisions about the people I serve 4.57 (SD = 0.91)

The behavior data recording sheets are easily accessible 4.57 (SD = 0.75)

Behavior data are important to my work 4.42 (SD = 1.03)

I do not have someone I can contact if I need clarification completing behavior data recording sheetsa 4.38 (SD = 1.14)

I do not find it helpful to review behavior data periodicallya 4.24 (SD = 1.2)

Recording behavior data does not help the people I servea 4.23 (SD = 1.32)

Training in behavior data recording has happened on my shift 4.19 (SD = 1.18)

My supervisor teaches me how to record behavior data recording sheets 4.18 (SD = 1.10)

There is enough time to record behavior data while on shift 4.10 (SD = 1.14)

I understand how clinicians use behavior data after it has been recorded 4.03 (SD = 1.08)

I have not been trained to complete data recording sheets in the programa 3.96 (SD = 1.45)

Behavior definitions are easy to understand 3.84 (SD = 1.12)

My other job tasks get in the way of recording behavior dataa 3.71 (SD = 1.38)

Behavior data recording sheets are not easy to fill outa 3.69 (SD = 1.40)

Additional training in behavior data recording would be helpful 3.64 (SD = 1.26)

I have been shown graphs of the behavior data we record in the program 3.54 (SD = 1.37)

Other staff record behavior data the same way 3.38 (SD = 1.33)

aIndicates reverse coding.

RICCIARDI ET AL. 461

the clinician when finished, yielding 100% return rate. Explanation, distribution, and completion of the questionnaire

during the group home meetings with participants lasted between 15 to 20 min.

3 | RESULTS

Table 2 presents the rank ordered average Likert scale rating for the 18 statements contained in the social validity

questionnaire. Eight of the 12 positively worded statements (66.6%) received an average “agree” rating (4.0–4.9) and

the remaining four statements (33.3%) received an average “neither disagree nor agree” rating (3.0–3.9). The stron-

gest endorsements from the participants were for their behavior data recording responsibilities, understanding the

value of behavior data recording, and the training and supervision to perform behavior data recording. More equivo-

cal ratings were documented for needing additional training, reviewing graphed data, and understanding behavior

definitions.

Three of the six reverse coded statements (50%) received an average “disagree” rating (4.0–4.9) and the

remaining three statements (50%) received an average “neither disagree nor agree” (3.0–3.9) rating. On average, the

participants disagreed about not having a contact person for clarifying completion of behavior data recording, finding

it useful to periodically review behavior data recording, and behavior data recording not being helpful to the people

served. More equivocal ratings pertained to not having been trained to record behavior data, other tasks interfering

with behavior data recording, and recording sheets not being easy to fill out.

4 | DISCUSSION

The present study illustrates the contribution of social validity assessment to issues of care provider training and per-

formance management within human services organizations (Luiselli, 2020). Specifically, the study targeted partici-

pant opinions and attitudes about the behavior data recording they were required to complete with adults who had

ID. As noted previously, many human services organizations rely on data recording by care providers to measure and

evaluate learning progress of the individuals served. Understanding how care providers perceive the practice, value,

and purposes of data recording informs organization administrators and supervising clinicians about operations prior-

ities, reasonable practices, and direction of future programming with service recipients. Notably, social validity

assessment ranks high as practice and research objectives within ABA and OBM (Ferguson et al., 2018; Gravina

et al., 2018).

The social validity assessment found that participants judged behavior data recording as practical (e.g., “The

behavior data recording sheets are easily accessible”), understood the objectives of behavior data recording (e.g.,

“Behavior data I collect are used to make decisions about the people I serve”), and saw merit in behavior data record-

ing (e.g., “Behavior data are important for my work”). Further, the participants endorsed high approval ratings for

behavior data recording training and supervision (e.g., “Training in behavior data recording has happened on my shift”

and “My supervisor teaches me how to complete behavior data recording data sheets”). These findings suggest that

participants working in the group homes managed by the human services organization were not negatively inclined

toward behavior data recording or would be expected to resist efforts directed at performance management. The

positive ratings also suggest that the participants would perform behavior data recording with good fidelity, that is,

consistently and accurately implement procedures they understood and approved.

Other participant ratings suggested elements of behavior data recording that group home supervisors could

focus on. For example, behavior data recording may at times be difficult due to competing activities (e.g., “My other

job tasks get in the way of recording behavior data”), the results of behavior data recording are not routinely shared

with care providers (e.g., “I have been shown graphs using the behavior data we take in our program”), and behavior

recording data are performed inconsistently (e.g., “Other staff and I record behavior data in the same way”). Relative

462 RICCIARDI ET AL.

to these findings, post-assessment meetings could be convened with participants in order to review how behavior

data recording could be improved through additional resources and support to ongoing training and supervision.

Although the focus of this study was on behavior data recording, the approach and format of social validity

assessment can be applied to many other areas of care provider performance such as delivering skills instruction,

implementing behavior support plans, and completing daily living routines. Questionnaires could also be developed

into surveys and checklists that measure implementation fidelity and isolate procedural compliance problems similar

to instruments such as the Performance Diagnostic Checklist-Human Services (PDC-HS) (Wilder, Cymbal, &

Villacorta, 2020).

We acknowledge that our social validity questionnaire included only some of many possible inquiries concerning

behavior data recording. For example, questionnaire items that judged the requirement of behavior data recording

compared to other participant job tasks or asked about alternative methods of conducting measurement would have

been informative. Further, some of the items might not be viewed as questions of social validation such as “I know

when I am responsible for recording behavior data” and “Training in behavior data recording has happened on my

shift.” These items were intended to touch on behaviors, conditions, and practical exigencies that impact direct con-

sumers and hence their ratings of social validity (Fawcett, 1991; Schwartz & Baer, 1991).

Two other aspects of the social validity questionnaire should be considered. First, the purpose of reverse coding

was to promote attentiveness from the participants by varying content of the questionnaire and to control for unidi-

rectional response tendency that can occur when items are worded similarly throughout (Swain, Weathers, &

Niedrich, 2008). Concerning the manner of distribution, a clinician was present when participants completed the

questionnaire in order to maximize return rate. However, this arrangement could have induced reactivity among the

participants and influenced their responses which to a large degree were favorable. Recall that the participants com-

pleted the questionnaire anonymously and they were also familiar with the clinicians, factors that may have lessened

possible reactivity. An alternative to this in-person format could have been the participants completing the question-

naire online without other people present although this method would not guarantee independent responding and

100% return rate.

The benefits of social validity assessment notwithstanding, there are several qualifications applicable to a perfor-

mance objective such as behavior data recording and similar competencies of human services care providers. On one

hand, social validity ratings by care providers may reflect approval, acceptance, and preference for procedures and

strategies that are not necessarily the most effective or have robust evidence support. It is also possible that social

validity ratings may not correlate with performance such as the case of care providers who rank behavior data

recording an organizational priority but do not follow established protocol or enter data reliably. In these situations,

observations of care providers would provide additional information to better interpret results of a social validity

assessment, for example, do care providers actually implement preferred procedures and demonstrate behavior that

conforms to their self-report?

Another consideration is evaluating care provider perceptions of the effects of programmed interventions and

system changes that were informed through social validity assessment. That is, how do care providers judge organi-

zation follow-up to questionnaire and survey data, post-assessment focus groups, and respective recommendations?

Unfortunately, it was beyond the scope of the present study to design and evaluate organization interventions

directed at behavior data recording policies, training, and supervision based on the results of participant question-

naire ratings. Referencing the rank-ordered assessment findings (Table 2), intervention efforts could focus on expan-

ding training in behavior data recording, teaching participants how to interpret graphic presentation of behavior

data, and managing performance to ensure that behavior data are recorded the same way. This process also high-

lights the need for human services organizations to assess social validity at regular intervals that are tied to selected

initiatives, large-scale policy changes, and reoccurring events such as hiring new staff (“onboarding”).

Generalization of our findings to other human services organizations must be interpreted cautiously given differ-

ent types of behavior data recording, training, and supervision conducted in those settings. As well, study results

should be qualified because this was a descriptive study with a convenience sample that concerned a single

RICCIARDI ET AL. 463

performance objective among care providers. Finally, it is unclear how items in the social validity questionnaire corre-

lated or comprised separate domains because a test of sampling adequacy (Kaiser-Meyer-Olkin Test) indicated insuf-

ficient data and sample size to perform a principal component analysis.

In addition to the previously cited goals and benefits, social validity assessment can contribute to care provider

professional development by demonstrating that human services organizations seek and value their opinions (Hewitt

& Larson, 2007). Having input into organization operations further enhances the self-image of care providers in the

demanding role of service delivery with persons who have ID (Kessler & Troxel, 2019). The present study described

the process of designing and evaluating a social validity questionnaire that focused on a performance priority of care

providers at a human services organization, described implications of the findings, and supports the need for more

widespread application of social validity assessment in behavioral practice and research (Ferguson et al., 2018;

Gravina et al., 2018).

ACKNOWLEDGMENT

The authors gratefully acknowledge the care providers at Seven Hills Community Services for participating in the

study.

CONFLICT OF INTEREST

All of the authors declare that they have no conflict of interest.

INFORMED CONSENT

Informed consent was obtained from all participants included in the study.

ETHICS STATEMENT

All procedures conducted in the study were in accordance with the ethical standards of the institutional and/or

national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical

standards.

DATA AVAILABILITY STATEMENT

Research data not shared.

ORCID

James K. Luiselli https://orcid.org/0000-0001-6989-9155

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How to cite this article: JN Ricciardi, AW Rothschild, NM Driscoll, et al. Social validity assessment of

behavior data recording among human services care providers. Behavioral Interventions. 2020;35:458–466.

https://doi.org/10.1002/bin.1730

466 RICCIARDI ET AL.

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