To illustrate application and outcomes regarding the staff training and supervision process for changing activities in a center-based program, two case examples will be described. Both examples involved a group of adults with developmental disabilities including autism within one agency. The participants attended the day program from 9:00 a.m. to 3:00 p.m. In both groups, two staff members were responsible for planning and implementing activities for their respective participants during the day program routine.

Group 1

Individuals in Group 1 had autism and communicated mainly through actions and facial expressions although two individuals used a small number of manual signs. One individual in the group was visually impaired and all participants displayed challenging behavior including aggression, self-injury, and stereotypy. Training needs for individuals in the group centered around increasing communication, work, money management, domestic, and self-care skills while also reducing problem behavior that interfered with the individuals’ ability to live and work in more independent settings.

Summary of Staff Training and Supervision Procedures for Clinicians to Change Nonmeaningful Activities

Initial Training

Hold an initial training meeting to discuss rationale, guidelines, and expectations for changing activities and to set a date for follow-up meeting

Supervisory Prompting

After the initial training meeting and prior to the follow-up meeting, visit the classroom one or two times to note any new activities and prompt staff planning for new activities

Follow-Up Training

Hold a follow-up meeting to provide feedback on observed changes, prompt ideas for further improving activities, resolve identified obstacles, and set a date for beginning formal observations.

Positive and Corrective Feedback

Begin posttraining observations

Following each posttraining observation: (1) provide positive feedback to both direct support staff and supervisor (if the clinician is not the supervisor) for observed meaningful activities, and (2) provide corrective feedback for observed activities that are nonmeaningful

Continue frequent observation and feedback until the level of meaningful activities is at an acceptable level

Provide intermittent feedback to maintain meaningful activities

During the time the individuals attended the center-based program, they worked on what staff described as prevocational activities such as sorting, packaging, and assembling a variety of materials—none of which were paid work. Individualized teaching also occurred in the center by a staff person pulling an individual from an ongoing activity for a brief one-to-one instructional session. For example, a money management teaching session involved an individual being instructed for 10 trials to point to a named coin from among pictures of several different coins. A teaching session for manual communication consisted of the individual being asked to make the manual sign for each of 10 words spoken by the instructor. In both the mornings and afternoons, the group had a coffee break and lunch occurred about mid-day. The group also attended a number of recreational activities interspersed across the week such as going out to eat, shopping trips, and exercise-related activities.

Prior to beginning the training and supervision program, Group 1 already had a busy daily routine. The primary concerns for this group were that a small number of activities and instructional materials did not meet the guidelines for meaningful tasks. While participating in the initial training meeting conducted by the supervisor, the staff correctly concluded that some of their instructional sessions could be more meaningful if integrated within other ongoing activities and by utilizing materials that were a natural part of the activities. Hence, instead of teaching money management skills during isolated sessions using pictures of coins, teaching began to occur when the individuals were spending their actual money during recreational and shopping trips. Manual signing also began to be taught in the context of ongoing activities such as teaching the sign for “cup” when a cup was needed during coffee break or teaching the sign for “help” when an individual needed assistance with a work task. When the supervisor observed these changes during visits to the classroom during the supervisory prompting phase of the program, staff efforts were praised and staff were informed they were on the right track. Subsequently, staff continued to design teaching sessions that were meaningful with only occasional corrective feedback from the supervisor.

Changing from prevocational work to more meaningful work for Group 1 took more time. Following the initial training meeting, staff replaced the prevocational materials with samples of materials used in contract work from a sheltered workshop operated by the same agency. However, the work activities remained segregated and unpaid. Over the next year, with continued observation and feedback from the supervisor, contract work was replaced with several other types of work that better suited the needs of the group. For example, work activities that involved mobility appeared to be more preferred by several participants relative to the seatwork associated with the sheltered workshop tasks. Therefore, a work enclave was formed to clean the agency’s dining room and kitchen following lunch, tasks for which the individuals were paid by the agency. Several of the participants also began to work part time outside of the agency in a small-press publishing company where they were paid to prepare books and advertising materials for mailing.

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