An Evidence-Based Protocol for Improving the Meaningful Utility of Center-Based Activities

Despite long-standing problems with the utility of center-based activities, human service agencies can provide meaningful services for adults with autism within a center-based context. To this end, an evidence- based protocol has been developed for assisting center-based programs in moving from nonmeaningful to meaningful activities. The protocol, based on applied behavior analysis research and application, has been successfully applied in a number of center-based programs to replace nonmeaningful activities with more purposeful and functional experiences for center participants (Parsons, Schepis, Reid, McCarn, & Green, 1987; Reid et al., 1985). Consistent application of the protocol has also been accompanied by meaningful activity participation of adults with autism that has maintained across years and even decades (Reid et al., in press). The basic steps of the protocol are provided in the following illustration.

Evidence-Based Protocol for Improving the Meaningful Utility of Center-Based Activities

Step 1: Specify criteria for meaningful versus nonmeaningful activities Step 2: Assess individual participation in meaningful versus nonmeaningful activities

Step 3: Develop and implement staff training and supervision plan for changing activities

Step 4: Continue assessment and supervision to maintain meaningful activity participation

Step 1 of the protocol for changing activities from nonmeaningful to meaningful involves specifying criteria for what constitutes these respective types of activities for adults with autism. Step 2 consists of

Quality Activities in Center-Based Programs for Adults with Autism. DOI: http://dx.doi.org/10.1016/B978-0-12-809409-9.00003-4

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assessing the degree of individual participation in meaningful versus nonmeaningful activities to determine if and what changes need to be made with the types of activities provided. Next, Step 3 involves carrying out staff training and supervision or consultation strategies for working with center staff to change the activities that are provided. Finally, Step 4 involves continued assessment and supervision to maintain the provision of truly meaningful activities over time. Each of the four steps of the protocol, which are described in detail in subsequent chapters, consists of a set of procedures that can guide efforts to improve the quality of a center’s daily services.

Before describing the specifics of implementing the protocol, consideration is warranted regarding the organizational structure of a center-based program in which the protocol is to be applied. The role of behavior analysts and related practitioners is particularly important in this regard. Successfully carrying out the protocol involves application of a number of basic behavioral procedures such as systematically assessing and monitoring the activity-related behavior of center participants and providing supportive and corrective feedback to staff. Implementing these and related behavioral procedures requires certain behavior analytic skills—skills in which certified behavior analysts are usually well versed. Consequently, the involvement of behavior analysts is usually critical in the overall change process. At a minimum, if practitioners do not already possess it, they should obtain practical training on behavioral approaches to staff training, such as behavioral skills training, and behavioral approaches to performance management, such as goal setting and feedback.

Behavior analysts can play an important role in changing the meaningful utility of center-based activities whether working in a consulting capacity with a center or as a full-time staff member. In both types of working relationships with a center, behavior analysts usually will need to take a lead role in the process. How to fulfill that role is laid out in Chapter 6, A Staff Training and Supervision Plan to Increase Meaningful Activities and Chapter 7, Maintaining Meaningful Activity Participation.

Although behavior analysts typically need to take the lead in using the protocol to improve a center’s activities, they should not act in isolation. In particular, they should strive to obtain significant involvement of a center’s supervisory personnel (if the behavior analysts themselves do not function in a supervisory position over direct support staff).

Two types of supervisors are most important to involve in the process: front-line supervisors of direct support staff and executive-level personnel such as managers of front-line supervisors and center directors.

The success of behavior analysts and other clinicians in changing center-based activities from nonmeaningful to meaningful is usually enhanced significantly if they actively involve supervisory personnel in the change process.

Involvement of the immediate supervisors of direct support staff is critical for two primary reasons. First, front-line supervisors have authority over the working situations of direct support staff (e.g., establishing their work and time schedules, providing performance evaluations, impacting pay raises). In turn, direct support staff are usually more responsive to directives and feedback from their immediate supervisors relative to agency personnel who do not possess such authority— rsuch as behavior analysts in many settings. Second, changing center activities from less to more meaningful frequently involves altering the work environment of staff. For example, often certain materials used in ongoing activities have to be replaced with different materials, the locations within which various activities occur may need to be changed, and in some cases the physical layout of certain areas within a center may need to be altered. Usually only personnel with at least some supervisory authority within an agency can make these types of changes.

The involvement of executive personnel, or upper management, in applying the protocol within the overall change process is important for the same reasons as just noted with front-line supervisors. Additionally, making changes to promote truly meaningful activities for adults with autism involves modifications in the day-to-day mission and expectations of what takes place within a center-based program to at least some degree. The latter alterations almost always require executive action and approval to be successful. Executive approval may also be needed for budgetary alterations, material procurement, and resolving issues with transportation needs. Finally, although executive personnel typically are not as integrally involved as front-line supervisors in the activity changes that take place on a day-to-day basis, their support of the staff supervisors and behavior analysts in making the changes is usually a critical factor affecting the ultimate success of the process.

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