The Relation Between Positive and Negative Staff-Resident Interactions and Effectiveness of Psychosocial Treatment Programming in Residential Mental Health Facilities
Staffing for residential treatment facilities serving mentally ill clientele has been based on the positive relationship between staff-resident ratios and effective programs. Actual attention received from staff members, however, is a better predictor of outcome than staff-resident ratios. Best outcomes have been achieved with a comprehensive social-learning program. If specific components of such programs could be identified as contributors to effectiveness, program directors could improve outcomes prior to launching a full-scale social-learning program. Positive (verbal and nonverbal) and negative (verbal and nonverbal) staff-resident interactions were promising candidates. Data were analyzed from 673 adult mentally ill residents with short and long stays in 22 treatment units. Separate hierarchical regression analyses revealed the best social-action measures of unit effectiveness—community tenure and net-gain in significant release, residualized to remove confounding variables—were both strongly predicted by the combination of positive and negative staff-resident interactions and staff-resident ratios. The addition of average hourly rates of these specific staff-resident interactions to staff-resident ratios significantly improved prediction of both residualized effectiveness measures. The combination of positive and negative staff-resident interaction category scores accounted for all of the improved prediction of unit effectiveness that had been accounted for by actual attention received from staff. This finding appears to be the result of these four category scores serving as proxies for the overall SRIC profiles of the two most effective programs in the sample—specific social-learning and milieu programs. These results suggest that positive and negative staff-resident interactions, contingently applied according to social-learning principles, should be the first focus in staff training for implementation of evidence-based procedures in residential programs.