When significant changes in virtually all daily activities are needed, as was the situation for Group 2 in the case examples, concentrating staff efforts on just small portions of the day, one at a time, has several advantages. First, staff may be less overwhelmed if they are planning and implementing ideas for an hour or so versus the whole day. When not overwhelmed, staff are more likely to follow through on ideas. Second, a clinician’s time can be used more efficiently if he/she knows when to be present in the group to observe and give feedback on new activities (i.e., during the specific time period and activities targeted for change). Third, as staff successfully implement changes in one time period, they can sometimes apply what they learned to the next period and subsequently require less assistance from the clinician over time. Fourth, as staff change to more meaningful activities in a single time period, they often report enjoying the new activities more than the nonmeaningful activities that occur during other time periods and become eager to make changes during other times of the day.

When activities during the day become more meaningful, staff also frequently find that identifying useful skills to teach to participants becomes more straightforward. For example, with the new schedule in Group 2, many opportunities became apparent for embedding the teaching of domestic skills during the coffee break and lunch routines. Communication instruction likewise was readily embedded by teaching greeting skills during the morning arrival routine. It should be noted, however, that direct support staff often need training to learn how to embed teaching within ongoing, natural routines to promote active participant involvement in the routines. Chapter 7, Maintaining Meaningful Activity Participation, addresses how this type of need can be met.

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