Group 2

Initially, staff in Group 2 had difficulty generating ideas for activity changes and required significantly more attention from the supervisor relative to Group 1. Also, Group 2 did not have a well-structured daily routine. During the time the individuals attended the day program, they spent most of the day doing leisure activities such as listening to music, coloring, looking at magazines, and manipulating a number of child-like toys such as pegboards and puzzles.

The individuals in Group 2 were more diverse than those in Group 1. Two of the individuals had autism. The four other individuals in the group had severe intellectual disabilities and one had a severe hearing impairment. None of the individuals communicated in conventional ways. Training needs included basic self-care, domestic, communication, and leisure skills. The day program site for the individuals in Group 2 consisted of a small suite of rooms including a kitchen.

During the initial staff training meeting, the staff in Group 2 were reticent to make any changes in activities. Their contention was that due to the severe intellectual disabilities of the individuals in their group, the child-like activities were appropriate. Relatedly, the staff seemed overwhelmed with how to make the activities in their group more meaningful. The supervisor suggested the staff begin by concentrating on making changes during only small parts of the day rather than tackling activities throughout the day all at one time. The supervisor began by making suggestions about ways to change the first 30 minutes of the day during the time the individuals were arriving at the day program. Activities suggested for the morning arrival routine focused on the staff instructing, prompting, and reinforcing participant independence (vs the staff continuing to perform the activities for the participants) and included:

  • • Taking off and hanging up coats
  • • Placing personal items (e.g., purse, special snack) in a locker
  • • Checking in by moving a photo of themselves from the “out” board to the “in” board
  • • Finding assigned work space
  • • Making a choice about a morning activity
  • • Saying or signing “Good Morning” to other group members

The arrival routine remained the focus of observation and feedback until the data indicated that activities associated with the first 20—30 minutes had improved. Staff were praised for successfully changing to more meaningful activities and effectively promoting participant involvement in the early morning routine. Next, staff were asked to concentrate on changing the activities between arrival and the morning coffee break while continuing the activity changes made with the early morning routine. The supervisor suggested ideas for service-based work that the group could be paid to do within the agency during this time period. Ideas included:

  • • Collecting, shredding, and bagging discarded agency paperwork for confidentiality purposes
  • • Collecting, washing, crushing, and bagging aluminum drink cans to be taken to the recycling center
  • • Collecting the plastic rings that were on the tops of 6-packs of sodas used in the agency to be snipped into small pieces before discarded into a landfill (to prevent wildlife from ingesting the entire rings)
  • • Breaking down cardboard boxes generated from deliveries to the agency for recycling
  • • Collecting and delivering mail within the agency
  • • Planting, weeding, and watering a flower bed
  • • Washing, drying, and folding towels used by the agency
  • • Placing address labels on agency bulk mailings

When observations indicated that the first hour and a half of the day had improved, the coffee break routine was the next period targeted for change. Observations of the coffee break indicated that the activity itself could be meaningful except that staff were completing most of the tasks associated with the coffee break rather than being performed by the group participants. A list of ideas for activities that group members could be assisted in learning to do during coffee break included:

  • • Obtaining napkins, cups, spoons
  • • Placing condiments like cream and sugar on the table
  • • Making the coffee
  • • Pouring the coffee
  • • Making choices about condiments to put in coffee
  • • Discarding trash
  • • Placing cups in the dishwasher

The process of changing to more meaningful activities subsequently continued with other time periods throughout the day, targeted one by one. For example, activities for the lunch routine were similar to the coffee break routine such that the same types of changes could be made to more actively involve the participants. The thrust of improving the afternoon leisure period was to make the activities more age- appropriate such as taking a walk, listening to popular music through headphones, adult crafts, and interacting with the computer. Childlike leisure materials were discarded.

Finally, activity suggestions for the last 15 minutes of the day were associated with transition to home such as:

  • • Putting away materials
  • • Wiping table tops
  • • Getting coats and personal items
  • • Checking out by moving pictures from the “in” board to the “out” board
  • • Saying or signing goodbye to group members
  • • Turning off the lights
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