A supported routines approach to active treatment for enhancing independence,competence and self-worth

The traditionally accepted approach to treatment in residential facilities for adults with mental retardation is examined in terms of its impact on the lives of the intended recipients and its interaction with emerging standards for treatment. It is noted that the primary emphasis in traditional treatment providing services to meet individual needs often results in the preponderance of service being directed toward the acquisition of skills required for later independent living, rather than the immediate facilitation of independence. We offer several reasons why a heavy emphasis on skill building is not only impractical but also inappropriate for meeting the real needs of adults with retardation. We suggest that a functional definition of independence from the individual's perspective would be to have a daily routine that is as free of outside assistance as possible and that is rewarding to the individual. We suggest that many persons with mental retardation already exhibit a sufficient array of behaviors from which appropriate personal routines could emerge. It is argued that functional assessments of the need for new skills should be conducted only from within such routines. We conclude that active treatment provided in this way will improve individual self-worth because its focus is on producing immediate competence and independence, rather than perpetuating the ‘student’ status of adults in residential facilities. We refer to this as a ‘supported routines’ approach. The implementation of this approach within the current standards for ‘active treatment’ is discussed, as well as the individual's right to be supported in this way.