Interview conducted by Mary Jane Weiss, PhD, BCBA-D
Association for Science in Autism Treatment
I recently had the opportunity to speak with the Leadership Team at Melmark and ask them some questions about how Melmark delivers services, trains staff, and fulfills its mission.
Questions for Rita Gardner, MPH, LABA, BCBA; President and Chief Executive Officer
Mary Jane: Can you explain how Melmark’s mission impacts service delivery on a daily basis
Rita Gardner, President and Chief Executive Officer
Rita: Melmark’s mission impacts daily service delivery by always keeping our mission first. We are committed to a framework of organizational decision-making that is always guided by how it strengthens the implementation of our service models. By being Mission First, we ensure that our greatest commitment is the allocation of resources at the point of care. Continuous monitoring of our service delivery at every level of the organization enhances the lives of those we serve by delivering exceptional special education, support, and treatment services that are evidence-based. We challenge ourselves daily to never be comfortable where we are, and to always be reaching for improvements in our system of care. To meet those challenges, we must have an ongoing commitment to professional development, training, and research.
Mary Jane: Melmark has integrated Organizational Behavior Management (OBM) strategies into every aspect of the organization, such as in staff training practices, supervision training, and the evaluation of organizational outcomes. How do policies and procedures work to improve clinical outcomes and organizational efficiencies?
Rita: Our professional staff use these strategies, as guided by our policies and procedures, to ensure consistent application of our systems including assessing the fidelity of our treatment and services. By ensuring the fidelity of treatment in all we do, we guarantee the best outcomes for the people we serve. The use of OBM has allowed us to continually improve all aspects of our service delivery, including improving staff skills, reducing administrative redundancy, and making sure our organizational/administrative requirements are efficient. In improving organization systems and efficiencies, we focus on providing sufficient time and resources to our working clinical supervisors, so their focus is always on the individuals we serve. As an organization, we are always clinically focused from the CEO to our direct care staff. Our vision is to continue expanding and raising the quality of our service delivery systems using OBM to continually measure and track our performance. Our analysis of that performance data informs all organizational decision-making. It drives service innovation and creativity as well as allows for significant applied research across our settings. Our extensive dedication to the best outcomes is reflected in the quality of services we deliver.
Questions for Frank Bird, MEd, LABA, BCBA; Vice President and Chief Clinical Officer
Mary Jane: Melmark is known for serving individuals with very challenging behavior. What are the successful ingredients for producing socially significant outcomes for this population of learners?
Frank Bird, Co-Founder, CCO and Vice President
Frank: This question can be best answered by understanding our core commitments at Melmark. We start by establishing a culture that underscores the significance of providing ongoing care, support, and respect for the individuals we serve, their families, and our staff. We employ performance-based training and professional growth to enhance the skill set of all staff, and we consistently assess the fidelity of our clinical, organizational, and staff training systems to ensure our standards of excellence are achieved and maintained. These commitments are employed within our practice of using scientific evidence and performance data to inform our decisions while emphasizing best outcomes in the quality of life of the individuals we serve. In all aspects of intervention, Melmark partners with parents to get input on goals and barriers to identified outcomes, so that intervention leads to changes that are enduring and meaningful.
Mary Jane: Melmark was an early adopter of an evidenced-based practices (EBP) policy. How does Melmark’s commitment to EBP inform and influence the selection of procedures to increase skill acquisition and reduce the interference caused by challenging behaviors?
How does Melmark’s active research program assist in this part of the mission?
Frank: At the onset of developing our program in New England, we were committed to providing treatment approaches that had a documented history of effectiveness in teaching new skills and treating aberrant behaviors, for we knew this was a critical prerequisite in the process of protecting the rights of our students. We developed our clinical manual based on incorporating scientifically-based treatment methodologies tailored to meet the individual needs of our students and simultaneously established staff training standards that required staff to understand the science and the importance of making data-based decisions. The guiding clinical principle across all of Melmark’s programs is to provide the most effective and least restrictive strategies to ensure our consumers have the opportunity to advance to their highest capability. Our ongoing immersion in clinically significant research assists us in continually revising clinical procedures and training protocols.
Mary Jane: One final Question: Why has Melmark chosen to sponsor ASAT at such a high level?
Frank: ASAT’s mission completely mirrors the mission and values of Melmark. Like ASAT, Melmark places a prime value on evidence-based practice, adopting and recommending only strategies that have been empirically validated. Furthermore, Melmark supports ASAT’s mission of disseminating accurate information about science-based treatment of autism. Families and practitioners are inundated with information that can be confusing and misleading. ASAT is a reliable leader in the fight against fad treatments, separating hype from hope. We are grateful that such a resource exists and are happy to support ASAT!
Questions for Helena Maguire, MS, BCBA; Executive Director, Melmark NE
Mary Jane: You have led the development of innovative staff training programs. What are the most important messages you can give to service providers about how to ensure effective and efficient staff training that maximizes client outcomes?
Helena: An effective and resource-efficient training technology is needed to prevent treatment-integrity failure and promote best outcomes for those we serve. Acceptable, efficient, and effective training programs have demonstrated that they can produce a higher level of a skilled workforce, lower levels of turnover, and strong client outcomes. It is important to recognize that expertly training human service staff will make a large-scale impact on consumers.
We use an evidence-based approach for training performance skills in human service staff, rather than relying on traditional didactic approaches, and we ensure follow-up supervision procedures are in place to monitor staff performance and to provide valuable feedback. In these ways, we hone staff performance, which has a profound effect on staff skills and longevity, as well as securing maximal client outcomes.
Evidence-based staff training should consist of performance-based and competency-based strategies and must require that observational data are collected to document that support staff demonstrate the target skills at the established proficiency criteria. In addition, the maintenance of mastered skills and the ongoing assessment of treatment integrity ensures that intervention remains effective, efficient, and state-of-the-art.
Mary Jane: You have developed a supervision training program that prepares individuals for supervisory and management roles within Melmark. What have you found to be the essential ingredients that prepare staff members for roles involving clinical oversight?
Helena: To support the proficient work behavior of direct care personnel in human service agencies, one factor that needs to be assessed on a consistent basis is the quality of ongoing supervision, training, and feedback provided. Often, staff members enter supervisory roles because of their proficient performance in direct service; yet they have had little or no supervisory experience or training. Performance management interventions in educational and clinical settings have influenced a wide range of employee behaviors that are critical to the organizational mission.
Supervisory success is achieved by providing a comprehensive training program, effective feedback, and follow-up monitoring sessions. This support of employees as they develop supervisory skill sets leads to effective supervisory behaviors, excellent pyramidal skills training of staff (in which layers of staff members are trained sequentially), and high levels of client treatment integrity.
Training supervisors in building rapport with staff, utilizing evidence-based feedback skills, and consistently applying effective reinforcement procedures do enhance the use of supervisory feedback and, in turn, the maintenance of staff performance.
Questions for Karen Parenti, MS, PsyD; Executive Director, Melmark PA
Mary Jane: Melmark PA serves many aging individuals with developmental disabilities. What are the unique challenges that this population presents, and how has Melmark accommodated their unique and complex needs?
Karen: We recognize that providing care to adults with developmental disabilities who are aging and/or medically complex is nuanced and that there are many aspects of care that must be taken into consideration. A multidisciplinary approach is essential to ensuring the individual is supported medically, behaviorally, and in terms of developing functional communication and adaptive living skills. Adjustments are often needed as physical and mental status changes. These include but are not limited to changing physical needs that require home modifications, changing healthcare needs, and the emergence of psychiatric and neurological needs related to aging, such as dementia. Naturally, such adjustments also mandate environmental changes, which may include increased mobility and access (e.g., accessible doorways and entrances, wider doorways), the use of additional prosthetics (walkers, wheelchairs), and alterations in lighting and signage.
Additionally, we stress the importance of a highly skilled workforce; therefore, to serve our adults more comprehensively as they age, we invested in more nurses with an RN credential which allows for more robust ongoing assessment and monitoring of our individuals’ complex medical needs. We also have invested in training several of our managerial staff in geriatric care skills, to ensure they can lead with knowledge and model essential skills for direct care staff.
We also believe that ongoing training for our direct support staff is essential to providing the highest standard of care. We provide training using a behavior skills training model (BST) on areas beyond the regulatory requirements such as varying medical diagnoses, applied behavior analysis, Hoyer Lift training, repositioning, wound prevention, and dysphagia. The focus on training across medical and behavioral targets is essential to providing quality care across the lifespan.
Additional attention is given to the issues that often arise with cognitive and behavioral changes associated with aging. For example, staff members are trained to be vigilant about the signs of dementia that commonly occur in individuals with Down Syndrome. In addition, individualized strategies are developed to enhance orientation and engagement in clients impacted by dementia and to support them with palliative care and the continuity of effective services.
Mary Jane: The Commonwealth of PA has a strong mandate that organizations increase the inclusion of individuals with disabilities in the broader community. How has Melmark met this mandate?
Karen: We are committed to ensuring that our individuals are included in the broader community. As such, we have invested in hiring additional staff and have purchased more vehicles to increase community participation. Additionally, we have several staff members who have received employment specialist certifications to assist our individuals in obtaining and sustaining inclusive, competitive employment in the community. We have also built strong partnerships with businesses in the local area to ensure our individuals have diverse volunteer and employment opportunities.
Perhaps most important, we have integrated community inclusion into our outcomes assessments and consider it to be a major component of quality of life for participants. Data are collected on the extent to which each individual is included in community outings, for employment, and for recreational purposes. Preferences are continually evaluated, and preferred activities are routinely offered to everyone.
Mary Jane: I want to thank all of you for sharing your clinical and organizational wisdom. Melmark serves as a model for other organizations that wish to embed ABA into all aspects of service delivery and professional development. We are also grateful for your Partner level sponsorship.
Citation for this article:
Weiss, M. J. (2019). An interview with the executive team at Melmark: Rita Gardner, Frank Bird, Helena Maguire, and Karen Parenti. Science in Autism Treatment, 16(5).
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