ONGOING SUPPORT AND OVERSIGHT
Ongoing support and oversight of staff are necessary throughout the duration of an intervention study and are an important quality control feature of behavioral intervention studies at any phase along the pipeline to ensure fidelity. The fidelity monitoring required in intervention research may involve direct observation of performance of staff and/or rating audiotaped sessions. Staff may not have had previous exposure to this level and type of oversight, so it is important that they be informed of its methodological importance and that they become comfortable with such approaches. Interventionists and interviewers in particular must be willing to receive direction, feedback, and redirection if drift or deviations from protocols occur.
For interviewers and interventionists (active treatment or control group conditions), ongoing oversight may be accomplished by listening to approximately 10% to 20% of randomly selected audiotapes, and directly observing interview or intervention sessions, case presentations at staff meetings, or one-on-one or group supervision sessions, or a combination thereof. Regular project meetings for the entire team are also important to ensure cohesiveness and ensure that the study remains on track. Clearly articulating the need for this level of oversight during the hire/inter- view process can help to avoid any misunderstandings or surprises down the road.
The organization and frequency of staff meetings will vary by project and its needs. Separate meetings with interviewers and interventionists may be necessary when keeping interviewers masked to the group allocation of participants. Any team meetings, however, should cover issues related to coding questions, review of completed assignments and scheduled interviews, troubleshooting, and case presentations. Also, team meetings present an opportunity to nurture essential team values such as mutual respect and a shared mission/goal and can be used to validate the hard work being done by individuals and recognize individual and group successes (e.g., meeting enrollment targets). As staff members themselves will reflect diverse skill levels, cultures, values, and beliefs, using meetings to model respect and to demonstrate how the contributions of each member are valued and important can go a long way to strengthen buy-in and build an effective team.
Finally, investing in the well-being and professional development of each team member is always important even when staff are hired for brief or time-limited periods. Interviewing or interacting with vulnerable populations and very ill, distressed or depressed study participants can be stressful. Attending to the staffs emotional reactions, encouraging the sharing of experiences in the study, and assuring their personal safety can help alleviate the stress, sadness, and attachment that may form with study participants (Lawton et al., 2015). This is typically an undervalued activity, yet one that is critical. It not only promotes the well-being of staff but also serves to strengthen commitment to the quality of the study.
Similarly, meeting with each staff member to identify reasonable professional goals within the scope of his or her study roles and responsibilities and offering opportunities for professional growth not only contribute to retention but also help to build an effective work force for behavioral intervention research. An interviewer may aspire to help train new interviewers and take on a study-monitoring or public-speaking role; a project coordinator may want to improve his or her public-speaking and writing abilities and participate in dissemination of findings. Staff development should be valued as a generative activity (e.g., preparing the next generation in research activity) and part of our ethical practices as behavioral researchers.
As an investment needs to be made in identifying, training, and supporting staff, it is of interest to an investigator and the team to keep people employed. However, this is often challenging if funding is not available beyond the scope of the specific project for which a staff member is hired. Moving staff from one study or phase of the intervention’s development to the next is desirable, but this can be difficult to always achieve. Challenges for doing so involve securing funding and having seamless transitions from study to study or finding “gap” or bridge funding (e.g., internal funding from one’s institution for a brief period until external funding is obtained) to support key personnel.