Restraint safety in a residential setting for persons with intellectual disabilities

The primary purpose of this study was to estimate the risks associated with the use of emergency personal restraints at a residential facility for persons with intellectual and developmental disabilities. A secondary purpose was to determine if correlates of restraint‐related injury could be determined. One in three restraints resulted in an injury, but all of the injuries were minor. In terms of prediction, frequency of aggressive behavior use was the best single predictor of restraint‐related injury. Copyright © 2009 John Wiley & Sons, Ltd.     

Microcomputer-based programmed instruction in identity matching to sample for persons with severe disabilities

Three individuals with mental retardation, who had failed to learn identity matching to sample with standard fading and prompting procedures, were given microcomputer-based programmed instruction. The methods were based on an analysis of two features of typical identity matching procedures: (a) within each trial, the current sample stimulus must control comparison selection, and (b) across trials, specific comparison stimuli must function both as S+ and as S–, depending upon the sample presented (conditional discrimination). During the first phase of training, one-trial acquisition of discriminative stimulus control was established in a nonconditional discrimination context where the S+ or S– functions of specific stimuli did not change from trial to trial. After one-trial learning was established, conditional discrimination was programmed by gradually introducing reversals of S+/S– stimulus functions. All three participants learned to perform conditional identity matching. Avenues for further analysis of the prerequisites for conditional discrimination and continued development of programmed methods are discussed.     

Employing persons with severe disabilities: much work remains to be done

This article presents statistical data depicting the employment of persons with disabilities at a federal installation using a recruitment intervention designed to increase the presence of persons with disabilities. The data were obtained by reviewing archival recruitment accessions that span 5 years (1999–2003). The organization under study is a highly technical Department of Defense organization constituted primarily of engineers and scientists and has been in existence and a major contributor in national defense for many years. Earlier recruitment data are not available.     

Validation of technical criteria for setting IPP goals for persons with developmental disabilities in residential settings

Data were collected from documentation from an annual IPP system on the technical adequacy of goals set and subsequently achieved. Goal characteristics coded included functionality of goal set (natural environment, natural materials, and age-appropriateness), ideological characteristics (community presence, choices and decisions, maintaining and developing competence, positive social role, and community participation), behavioral technical adequacy (named person responsible, achievement date, and stated in measurable terms), and curriculum domain. Multiple regression analysis revealed that goals that were written in a technically correct fashion and that involved functional skills were more likely to be achieved. A greater variety of life goals predicted fewer goals being achieved.     

Case study: Improving the social interactions of a group home resident with severe and multiple disabilities

A 43-year-old man with severe mental retardation and sensory impairments and a long history of behavior problems was taught to interact more appropriately with staff members at his community-based group home. The following behaviors were targeted for change within a multiple baseline design: use of an appropriate cueing response to initiate a conversation; keeping his hands to himself when conversing with another; and not ‘badgering’ people by repeating the same question over and over. Instructions and feedback produced small, unstable improvements in the subject's behavior. When token reinforcement was added to the treatment package, large and immediate improvements were noted. The improved levels of social interactions were maintained after token reinforcement was withdrawn, suggesting the operation of naturally occurring contingencies of reinforcement.     

Improving day-treatment services for adults with severe disabilities: a norm-referenced application of outcome management

We evaluated an outcome management program for working with staff to improve the performance of adults with severe disabilities in a congregate day-treatment setting. Initially, observations were conducted of student task involvement and staff distribution of teaching interactions across students in four program sites. Using recent normative data to establish objective goals for student performance, management intervention was warranted in two of the sites. A six-step outcome management program was then implemented in the two sites. The program involved defining desired student and staff outcomes, systematic monitoring of the outcomes, staff training, and supportive and corrective feedback. The outcome management program was accompanied by increases in student on-task behavior and staff distribution of teaching interactions in both sites. The increases brought the levels of on-task behavior above the normative average; on-task behavior was maintained above the baseline average for over 1 year in both sites. These results are discussed in terms of the benefits of relying on normative data for objectively evaluating and improving service delivery systems. Discussion of future research needs focuses on applying the outcome management program to other settings and services for people with disabilities.     

Corporate culture and the employment of persons with disabilities

This article addresses key questions arising from the economic and social disparities that individuals with disabilities experience in the United States. For instance, “What role does corporate culture play in the employment of people with disabilities?” “How does it facilitate or hinder their employment and promotional opportunities, and how can corporations develop supportive cultures that benefit people with disabilities, non‐disabled employees, and the organization as a whole?” Corporate culture can create attitudinal, behavioral, and physical barriers for workers and job applicants with disabilities. This research concludes that if the employment prospects of people with disabilities are to be improved significantly, attention must be paid to the ways in which corporate culture creates or reinforces obstacles to employees with disabilities, and how these obstacles can be removed or overcome. Ultimately, we will make the case that corporate culture and societal attitudes must change if people with disabilities are to be accepted and incorporated fully into the workplace. Copyright © 2005 John Wiley & Sons, Ltd.     

Case study: Examining the relationship between self-initiations of an individual with disabilities and directive behavior of staff persons in a residential setting

This case study examines the relationship between self-initiations of an adult woman with severe disabilities and the directive behavior of staff persons in a community residential setting. Hypotheses generated from functional assessment procedures indicated that (a) Susan's low self-initiations were very likely related to high directive behavior of staff persons, and (b) infrequent problem behaviors during the morning routine were maintained by escape from repeated staff demands. An intervention was implemented to enable Susan to increase self-initiation in choice and sequence of activities and simultaneously decrease staff directives. Results and discussion focus on the need for a contextual approach for addressing problematic situations and an affirmation of the effectiveness of the positive behavioral support technology for increasing adaptive behaviors in individuals with severe disabilities.     

Teaching socially valid social interaction responses to students with severe disabilities in an integrated school setting

To evaluate the effects of a procedure designed to teach appropriate social responses to adolescents with severe disabilities in an integrated school setting this study employed an ABA withdrawal design, replicated twice with two students, and an AB design with a third student. Social responses were recorded during daily training sessions and generalization probes. Treatment involved implementation, by the classroom teacher, of a constant time delay procedure utilizing nonhandicapped peers and a socially validated teaching curriculum. The results showed increases in correct responding and decreases in echolalia following intervention. Generalization of appropriate responding to nonhandicapped peers was demonstrated to varying degrees for all participants.     

A computer-based system providing pictorial instructions and prompts to promote task performance in persons with severe developmental disabilities

This study was aimed at assessing a new computer-based system to promote task performance in three adults with severe developmental disabilities. The new system, which was small and battery powered, could provide auditory and vibratory prompts in addition to pictorial instructions concerning the task steps. To control for the effects of the computer-based system, the subjects were also exposed to a card system. The results showed that the subjects had a significantly higher level of correct performance on the tasks presented with the computer-based system than on the tasks presented with the card system. Two of the subjects, moreover, seemed to prefer the computer-based system to the card system. © 1998 John Wiley & Sons, Ltd.     

Problem-solving training for family caregivers of women with disabilities: A randomized clinical trial

ObjectiveTo examine the effectiveness of an individualized problem-solving intervention provided to family caregivers of women living with severe disabilities.DesignFamily caregivers were randomly assigned to an education-only control group or a problem-solving training (PST) intervention group. Participants received monthly contacts for 1 year.ParticipantsFamily caregivers (64 women, 17 men) and their care recipients (81 women with various disabilities) consented to participate.Main outcome measuresCaregivers completed the Social Problem-Solving Inventory – Revised, the Center for Epidemiological Studies Depression scale, the Satisfaction with Life scale, and a measure of health complaints at baseline and in three additional assessments throughout the year.ResultsMultilevel modeling was used to conduct intent-to-treat analyses of change trajectories for each outcome variable. Caregivers who received PST reported a significant linear decrease in depression over time; no effects were observed for caregiver health or life satisfaction. Caregivers who received PST also displayed an increase in constructive problem-solving styles over the year.ConclusionsPST may benefit community-residing family caregivers of women with disabilities, and it may be effectively provided in home-based sessions that include face-to-face visits and telephone sessions.     

Microswitch programs for persons with multiple disabilities: an overview of the responses adopted for microswitch activation

Background: To introduce a person with multiple disabilities to a microswitch-aided program, one has to select a plausible response(s), that is, a response(s) that can be performed reliably and without excessive effort by the person and can successfully activate the microswitch(es) available (producing preferred stimuli). This paper provides an overview of the responses adopted for microswitch activation in research studies during the last 20 years. Method: Computerized and manual searches were carried out to identify the studies published between 1986 and 2005. Forty-eight research studies were identified. They concerned the use of (1) a single (typical) response, (2) a single (non-typical) response, (3) multiple (typical and non-typical) responses, and (4) multiple (vocal) responses. Results and discussion: The results showed that 151 of the 190 participants involved in the studies had a positive outcome (i.e., clear increases in their responding, which suggested that they had learned the association between responding and consequent preferred stimuli). Failures were largely concentrated in the first group of studies. The discussion focused on (a) the importance of selecting plausible responses for increasing the chances of success, (b) the need of non-typical responses for persons with minimal motor behavior, (c) implications of programs with multiple responses on engagement and choice, and (d) relevance of using vocal utterances. Some suggestions for future research concerning these points were also examined.     

Microswitch-based programs for persons with multiple disabilities: an overview of some recent developments

Persons with multiple disabilities are often unable to interact with their environment due to their limited response repertoire. Microswitch programs are designed to help them control environmental events, generally preferred stimulation, through simple (feasible) responses. To make microswitch programs a more widely usable and relevant resource for intervention with these persons, a number of new developments were pursued in recent years. This paper examines three of those developments as specifically addressed in our research activity, namely, (a) assessment of new, nontypical responses and matching microswitches, (b) fostering of multiple responses and exercise of choice, and (c) targeting of habilitative and clinical (therapeutic) objectives. The encouraging outcomes of these developments are reviewed in relation to their potentially wide implications for daily practice and the need of additional developments in the area.     

Cultural variation in management of attention by children and their caregivers.

Cultural variation occurred in time-sharing of attention during videotaped home visits with sixteen 14-20-month-old toddlers and their caregivers from a Guatemalan Mayan community and a middle-class community of U.S. European-descent families. The Mayan caregivers and their toddlers were more likely to attend simultaneously to spontaneously occurring competing events than were the U.S. caregivers and their toddlers, who were more likely to alternate their attention between competing events and, in the case of the caregivers. to focus attention on one event at a time. This cultural contrast in prevalence of simultaneous or nonsimultaneous attention occurred in both a 10-min segment of child-focused activities and a 10-min segment of adult-focused activities, replicating and extending the findings of B. Rogoff, J. Mistry, A. G?ncü, and C. Mosier (1993), which implicated cultural processes in attention.     

Program report: “time-in”: A two-year project for the reduction of severe maladaptive behaviors in a center for persons with developmental disabilities

The results of a two-year project designed to organize a unit for 18 developmentally disabled clients with severe behavior disorders (primarily aggression) were presented. Providing tightly organized structure and focusing on appropriate resident behavior resulted in substantial gains. Noted changes included significant decreases in aggression, total number of target behaviors, required uses of restrictive procedures, and residents' injuries. Decreases were also noted in staff injuries and turnover. Subjectively, the unit became a better place to work and live. Difficulties encountered with developing, maintaining, and generalizing the project were discussed.     

Stigmata and negotiated outcomes: Management of appearance by persons with physical disabilities

This paper explores the role of clothing in the management of appearances by persons with disabilities. A negotiated outcomes perspective is used to study the clothing choices of disabled persons, rather than viewing them as passive recipients of the labels supplied by perceivers. A two‐part study of college students with physical disabilities, including comments from a series of focused group interviews and open‐ended responses to a questionnaire with national distribution, resulted in the data presented. The data indicated that most of the students strived to appear as normative as possible through their clothing choices and accordingly used a variety of techniques: “making do” with ingeniously adapted ready‐to‐wear apparel; using clothes to conceal a disability; deflecting attention from a disability toward more normative but slightly discrediting attributes; compensation through fashionable dress or by emphasizing other social roles and abilities; and social inclusion, i.e., the assertion that all persons vary in physical appearance. Some students employed dress to take advantage of their social uniqueness through such techniques as wearing bright or prominent clothing or by displaying humor. Possible directions for future research on the social interactions of disabled persons, particularly involving the implications of normalizing appearance versus emphasizing social uniqueness, are presented.