Introduction

Residential group homes that support young adults with developmental and behavioral needs rely on dedicated staff to create a safe, effective, and ethical environment. Recognizing the critical role staff play in maintaining safety and quality can foster a sense of pride and accountability.

Global Care developed this Performance Management Plan in response to agency-identified concerns within a residential group home serving individuals ages 18 to 24. Among the most significant concerns reported were a lack of support for hygiene issues, inconsistent documentation practices, medication administration errors, and an increase in behavioral incidents. Given the number of staff members and the 24-hour service model, a comprehensive assessment of staff performance and organizational systems is warranted.

The assessment results will create a foundation for identifying staff strengths and areas for growth, inspiring confidence that targeted improvements will enhance service quality and staff competence.

Assessment

Global Care Inc, completed a structured set of assessments (see Appendices A, B, and C) to identify skill deficits, performance inconsistencies, and organizational variables affecting effective service delivery within the residential group home. The assessment focused on staff behavior and organizational processes related to medication administration, implementation of behavior intervention plans, hygiene support, and documentation practices. Multiple data sources, including documentation audits, direct performance observations, and a staff competency assessment, were used to examine staff performance across shifts and service contexts and to identify patterns of performance breakdown and training needs.

Staff Competency Assessment (Appendix A)

To ensure the competency of 14 staff members, a competency assessment was conducted. (see Appendix A) Results indicated that seven of the twelve direct support professionals did not demonstrate competency across one or more core performance areas, including medication administration, documentation expectations, and behavior plan implementation. Competency results for supervisors indicated variability in performance across staff monitoring, documentation review, and the delivery of performance-based feedback. Both supervisors demonstrated general knowledge of supervisory responsibilities but inconsistently applied structured performance-monitoring practices. Competency deficits were observed across both shifts, indicating gaps in system-level training and supervision. These findings suggest that both staff skill deficits and inconsistent supervisory support influence performance challenges.

Performance Observation (Appendix B)

A performance observation is conducted to assess a staff member’s ability to perform their daily duties effectively and efficiently. Based on observations completed during the morning and evening shifts, using a task-analysisbased checklist to evaluate staff performance during service delivery. Observations revealed inconsistent implementation of medication administration procedures, lapses in hygiene support routines, and lapses in behavior intervention plans (BIP) across shifts. Staff frequently omitted critical steps during medication administration, including verifying administration times and documenting them immediately. Hygiene support was often initiated but not consistently completed. Supervisory presence during observations varied between the two supervisors, and in-the-moment feedback was limited when performance errors occurred. These findings suggest that inconsistent supervisory monitoring across shifts may be contributing to ongoing performance deficits among staff.

Documentation Audit (Appendix C)

A documentation audit including daily service notes, incident reports, and medication administration records over four weeks. Results show inconsistent documentation practices across shifts and staff members. Approximately 40% of reviewed service notes lacked objective, behavior-based descriptions of services delivered. Medication administration records indicated that medications are not administered according to the prescribed schedule on approximately 25% of reviewed days, including multiple missed or delayed doses. Explanations for medication variances were frequently incomplete or absent. A review of supervisory records showed limited and inconsistent monitoring or follow-up of documentation accuracy.

Assessment Summary

Target Outcomes and Behaviors

Due to the deficits seen within the assessment at this home, the following performance outcomes were considered of utmost importance. Global care will work with the group home to train supervisors to increase consistent training practices across staff using Behavior Skills Training (BST) to teach and give ongoing feedback to their employees to increase accuracy across documentation to a permanent average accuracy of 90%. Documentation will include any forms needed for medication administration, those regarding behavior implementation plans (BIPS), incident reports and daily service notes. 90% accuracy rate is to give room for human error, which should be found and used as a training opportunity by supervisors reviewing documentation.

While the first performance outcome is to aid supervisors, Global care wants to help the company, working with the employees as well. Global care will work with employees to help them grow in confidence and consistency within their own skill set. Global Care will work with employees to increase implementation of hygiene support with their clients by completing a weekly hygiene chart that each client will have with their documentation (See appendix E). Hygiene charts should be filled to a permanent average accuracy of 80%.

To obtain these outcomes, Global care will have several smaller goals in place throughout the process. The first two goals that the supervisors would be working on would be worded as such: Supervisors will independently give feedback to staff when needed in the moment 10 times per day across 5 consecutive days. The other is that supervisors will audit documentation daily and have errors fixed on medication administration information to 90% accuracy for 2 consecutive weeks. Both are smaller goals but still give supervisors a large task to work on and keep up with for a consistent two-week period before more expectations are added. For the employees working with the hygiene chart, their first goal would be to complete 30% of hygiene tasks per week across 2 consecutive weeks across all clients. As they can reach this goal, the percentage will increase to that 80% for the complete outcome.

Training Procedures

1. Training Procedures for Staff

In order to improve how the group home runs, we would be bringing in a structured competency-based training program for the staff. The main goals will be to improve the fidelity of the BIPs, improve how medications are managed, improve the quality of documentation, improve the quality of support offered for hygiene needs for the residents, reduce behavioral incidents, and finally improve consistency in all these areas for all working hours. This is because its a 24/7 operation and we have several members of staff.

Training Model Selected

The training process will involve the use of Behavioral Skills Training, as well as performance management techniques from Organizational Behavior Management. BST is chosen due to the fact that it is one of the most well-supported methods of training human service staff, and it has consistently shown to be effective in improving treatment integrity and staff performance.

BST includes four components: Instruction, Modeling, Rehearsal, and Feedback.

Training Procedures and Implementation

Step 1: Initial Orientation and Instruction

All staff members will receive orientation, in which expectations and procedures are clearly outlined. This includes, but is not limited to, an overview of each residents BIP, procedures related to the administration of medication, documentation, hygiene support, and ethical and safety expectations, with written protocols and checklists available to reduce confusion.

Step 2: Modeling

The supervisors or trainers will model the correct implementation of BIP, correct documentation of medications, correct hygiene prompting techniques, and correct data recording techniques.

Step 3: Rehearsal (Role-Play and Practice)

The staff will be asked to rehearse the learned skills through role-playing, for example, handling behavioral incidents, documentation, hygiene prompting, and medication schedules.

Step 4: Feedback

Feedback will be immediate, behavior-specific, and given for correct and incorrect performances.

Step 5: In-Vivo Coaching

This will involve observing and coaching employees while on actual work shifts.

Step 6: Ongoing Monitoring and Booster Training

This will include weekly treatment integrity monitoring, monthly competency assessments, and booster training for skill deficits, as well as data-based decision making.

Rationale Grounded in Evidence-Based Literature

Behavioral Skills Training (BST) has strong support from the behavior analytic literature, indicating its effectiveness as a method for training staff in human service environments. Parsons, Rollyson, and Reid (2012) found that BST consistently enhances staff implementation of behavioral procedures, increasing treatment fidelity more than instruction alone.

Instruction alone is not adequate for bringing about performance changes. Modeling and rehearsal provide the staff the opportunity to learn skills by actively participating, while feedback enhances correct performance and minimizes incorrect responding. Performance feedback is considered the most powerful method for enhancing employee performance (Alvero et al., 2001).

OBM strategies such as checklists and performance monitoring are also helpful for the long-term maintenance of staff performance. Reid, Parsons, and Green (2012) highlight the importance of systems-level support to ensure long-term quality services in human service environments. Supervision and performance evaluation are also critical factors for maintaining high-quality behavioral services (Sellers et al., 2016).

Performance Monitoring

Performance monitoring will be completed with the use of two data sheets that have been created to use with the performance outcomes created. The first of these data sheets is the hygiene tracking sheet that has been created for all the clients (See Appendix E). This data will be taken and graphed at the end of the week to check for upward trends towards a 80% success rate. Graphing will be completed using a simple line graph, only showing the percentage of hygiene tasks completed per week. Within the graphs, phase lines will be added as the goals are completed and the supervisors and staff are working towards a higher percentage of success. Not only are graphs helpful to show behavior change, they are also helpful as a conversational aide to discuss the change with others (Cooper, et al., 2020). If there is a lull or downward trend seen, the visual of the graph may be used for training purposes with the staff to discuss why it may have been seen that week and what may be done to improve percentages again.

For the Supervisors, a separate graph will be created to use for the standardized quality rubric (see Appendix F) created to track weekly audits. A line graph will still be used with two dependent variables being shown within the data range. The dependent variables being tracked will include the medication administration audit and the incident review report. The graph will once again show weekly scores to show the trend working towards a 90% success rate. Both supervisors will manage their own graphs using the same data within the center. By doing this, they are increasing their procedural fidelity, being sure that they are both auditing and graphing correctly each week (Cooper et al.,2020). If the data is not the same within their graphs, audits should be redone until they are the same, making the interobserver agreement (IOA) 100%.

Feedback and Reinforcement

A. Feedback Strategies

Ensuring effective performance management is a key aspect of ABA. To ensure effective performance management in residential settings, it is important to have feedback that focuses on specific behaviors and is systematic. Reid et al. (2021) state that using OBM in providing feedback leads to interventions being implemented consistently and with fidelity, leading to improved client outcomes. In the residential setting, performance concerns include inconsistent documentation, inconsistent medication delivery, lack of fidelity of behavior intervention plan (BIP) implementation, and lack of support for hygiene programs for residents.

A multi-component feedback process will be implemented, focusing on coaching, performance meetings, and written feedback. During direct observation, immediate feedback will be provided through behavior-specific statements and explaining how this behavior impacts the residents that the supervisees are taking care of. Expected performance standards will also be included to demonstrate what is expected of the supervisees. Supervisors will review tasks analyses, checklists for medications, and documentation protocols when providing feedback. Supervisees who demonstrate skill deficits will receive additional training using Behavior Skills Training procedures.

Performance feedback meetings will be conducted biweekly to review performance data, treatment integrity, medication administration, and documentation. Daniels (2016) states that collaboration leads to increased performance. Thus, collaboration will help identify barriers and create short-term goals to meet performance expectations. Written performance summaries will be reviewed and include strengths, areas for improvement, and steps needed to improve. Feedback will be given privately and respectfully to maintain staff dignity. Along with this, there will be more positive feedback than corrective feedback to ensure positive behavior momentum.

B. Reinforcement Plan

A positive reinforcement plan will be implemented to increase staff performance and treatment fidelity. Reid et al. (2021) state that reinforcing staff performances leads to increased job satisfaction, consistency, and client performance. Reinforcement will be given when there is accurate documentation, medication is given appropriately, BIPs are implemented with integrity, and hygiene programs for clients improve. Staff performance will be monitored through reviewing documentation, medication administration, and data analysis of hygiene programs. This will determine if reinforcement is being delivered effectively.

A performance recognition system will be implemented. Staff will earn points, which will then be exchanged for reinforcers, including schedule preferences, small incentives, or recognition. Bacotti et al. (2021) state that incorporating staff preferences increases reinforcement effectiveness and performance. Behavior-specific praise will be constantly implemented to provide social reinforcement. This reinforcement system will be evaluated weekly, and modifications will be implemented if there is insufficient improvement.

Evaluating Outcomes

The goal of evaluating outcomes in this Performance Management Plan is to assess whether improvements in staff performance lead to meaningful, measurable changes in service delivery and resident outcomes. Following the principles of Organizational Behavior Management (OBM), outcome evaluation focuses on results rather than effort and uses objective, observable, and reliable measures (Alvero et al., 2001; Daniels, 2016). Outcome evaluation procedures directly relate to the identified performance outcomes for this residential setting: improved documentation accuracy, increased implementation of hygiene support procedures, better medication administration accuracy, and a decrease in behavioral incidents. Evaluating these outcomes helps Global Care Inc. determine the effectiveness of training, monitoring, feedback, and reinforcement systems, guiding decisions based on data.

Multiple outcome measures will ensure a reliable and thorough evaluation of performance. Using diverse data sources enables triangulation and increases confidence that observed changes reflect real improvements in staff performance (Cooper et al., 2020). First, documentation accuracy will be evaluated through weekly audits using a standardized quality rubric. Documentation accuracy will be calculated as the percentage of required elements completed correctly. Performance outcomes will be considered achieved when staff maintain an average accuracy rate of at least 90% across two consecutive weeks. Second, the implementation of hygiene support will be evaluated using resident hygiene charts (Appendix E). Completion will be calculated as the percentage of scheduled hygiene tasks accomplished per resident each week. An average completion rate of at least 80% across residents for four consecutive weeks will show that hygiene-related performance outcomes have been met. Third, medication administration accuracy will be assessed through weekly reviews of Medication Administration Records (MARs). Accuracy will be defined as correct adherence to the five rights of medication administration: right individual, medication, dose, time, and route. A sustained zero-error rate over four consecutive weeks will indicate achievement of medication performance outcomes. Finally, behavioral incident frequency will be evaluated using monthly summaries of incident report data. Incident rates will be compared to baseline data collected during the assessment phase. A reduction of at least 30% in behavioral incidents over three months will signal improved behavior, support implementation, and environmental consistency.

To ensure reliable measurement of outcomes, all evaluation tools are standardized and clearly defined. Supervisors will receive training on scoring procedures for documentation audits, hygiene charts, and MAR reviews. Interobserver agreement (IOA) will be checked on at least 25% of outcome measures, aiming for an acceptable agreement criterion of 85% or higher (Cooper et al., 2020). Using permanent products, such as documentation, MARs, hygiene charts, and incident reports, enhances reliability by reducing observer bias and enabling consistent evaluation across shifts and staff members. Decision-Making Supervisors and the consulting team will review outcome data monthly. Data will be visually displayed using simple graphs to examine trends, levels, and variability over time. If performance outcomes are not achieved, data will inform problem-solving decisions, which may include adjustments to training procedures, increasing feedback frequency, or modifying reinforcement systems (Van Houten et al., 2007). This outcome evaluation process ensures that performance management decisions are objective, defensible, and responsive to both staff performance and resident needs.

Barriers to Assessment and Training

A. Predicted Barriers to Assessment and Training

Environmental, organizational, and staff-related barriers can impact assessment accuracy and training effectiveness. Carr et al. (2013) state that performance problems result from antecedent variables, skill deficits, and motivational factors. Thus, these should be evaluated to determine what is impacting performance.

One possible barrier is that of competing job demands. Staff are expected to administer medication, document, support residents, and implement BIPs. Thus, this puts a time limit on when training is available and when performance can be monitored. Workload demands can reduce participation in training, leading to inconsistent implementation and documentation.

A second barrier is skill deficits in administering medication, implementing BIPS, and documentation. Lack of staff performance may be present due to limited modeling opportunities or practice. Without training, procedures can be implemented incorrectly, directly impacting client treatment. Motivational barriers could affect performance. If feedback is inconsistent or reinforcement does not align with what the staff wants, engagement can be reduced.

B. Strategies to Address and Prevent Barriers

Regarding workload and time constraints, supervisors should integrate training opportunities into the daily routines of staff. Job aids can also be implemented, including medication checklists, task analyses, and examples of complete documentation. Choi & Johnson (2021) state that clarifying expectations increases staff performance.

Skill deficit barriers will be addressed with training and performance monitoring. Checklists and documentation review will be implemented to monitor staff performance. This will then be used to identify which skill deficits are improving and which need further training. Sellers et al. (2016) state that competency-based supervision improves staff performance.

Motivational barriers will be addressed through clear performance expectations and consistent feedback, along with reinforcement that incorporates staff feedback. Biscotti et al. (2021) state that aligning staff preferences increases engagement and performance. Identifying barriers leads to the implementation of problem-solving strategies to increase staff performance.

Conclusion (Funnel Method!)