Burke, Amie M.

Fox, Robert A.

Fung, Michael P.

English

epublications@Marquette

Marquette Universitye-Publications@MarquetteEducation Faculty Research and Publications Education, College of8-1-2012A Long-Term Leisure Program for Individuals withIntellectual DisabilitiesMichael P. FungMarquette UniversityAmie M. BurkeMilestone, IncRobert A. FoxMarquette University, robert.fox@marquette.eduA Long-Term Leisure Program for Individuals with Intellectual Disabilities. National Association ofQualified Developmental Disability Professionals, Chicago, IL, 2012. PowerPoint presentation.• Community of 150,000 located in Rockford, IL - over 40 years• Non-profit agency serving over 400 children and adults with mild to profound intellectual disabilities• 30 adult group homes throughout Rockford• 600 staff members• Two residential facilities • Elmwood Heights – 84 adults• Rocvale – 50 children ages 6-21• Three Day Training Facilities• Milestone Training Center• Industrial employment training• Community Center • Leisure activities improve quality of life (Jerome, Frantino, & Sturmey, 2007; Thomas & Rosenberg, 2003)• Leisure decreases opportunities for inappropriate behaviors (Emerson & Hatton, 1996)• Meaningful activities and strategies have already been developed (Parsons, Rollyson, & Reid, 2004)• Advances in technology and teaching strategies (Dollar, Fredrick, Alberto, & Luke, 2012; Edrisinha, O’Reilly, Young Choi, Sigafoos, & Lancioni, 2011)• Staff training has been effective at Milestone and other agencies (Chou et al., 2011; Stancliffe, Harman, Toogood, & McVilly, 2008)1. Determine short-term leisure program efficacy2. Develop simple and reliable measure of staff-resident interactions 3. Establish long-term leisure program to improve quality of life4. Establish a standardized leisure program model (with individual variations)5. Expand over two years to four adult homes and five children’s homes • Multiple baseline design (Hersen & Barlow, 1976) • First home - baseline and treatment after eight weeks • Second home – extended baseline and delayed treatment • Homes measured at separate intervals for post-test and follow-up02468101214Male Home (14individuals)Female Home (14individuals)121389285 5Two Comparable HomesProfound RangeSignificant MedicalDiagnosisNon-ambulatoryPsychotropic Medication• Meaningful Client and Staff Interaction assessment (MCSI; Parsons, Rollyson, & Reid, 2004)1. Developmentally appropriate leisure activity2. Resident active participation, eye contact/smiling with staff3. Appropriate staff interaction, such as touch, tone of voice, or eye contact• Evaluation of MCSI1. Three random 30-second measurements of staff interactions2. Offered compliments, feedback, and suggestions to staff3. Staff typically unaware of observations 4. One-third of observations - inter-rater reliability (95.3%)• Residents voluntarily chose to participate in activities• Assessed for reinforcer preferences (games, activities, edible, liquids) individually and systematically • Reinforcement Assessment of Individuals with Severe Disabilities (Fisher, Piazza, Bowman, & Amari, 1996)• Approach behaviors identified (gentle touch, enthusiastic, limited eye-contact)Simple Board Games Arts/Crafts (e.g., magazines, coloring)Sound and Smell Sensory Activities (e.g., music, aromas)Tactile Sensory Activities (e.g., balloons, lotions)• Predictable daily activities (one hour in length each weekday immediately prior or following supper)• Staff rotated every 20 minutes (adapted) to ensure variety and knowledge with all residents• Activities located in bins for easy access• Ineffective activities replaced (ongoing assessment)• Staff input on activities (empowered staff)• Met with psychologist regularly to discuss challenges• Four direct care staff members in each group• Psychologist explained program rationale and importance of routine• Home supervisor oversaw implementation and training of staff • Individual reminder cards with reinforcer information• One staff managed activities, another clean-upSupervised role-play of activitiesIn-home observation of supervisory staffSupervised in-home implementationIndependent implementationFour-Step Process• Initial increase7.25% - 89.86% Female home5.71% - 84.77% Male home• Follow-up 88.40%Female home 89.60% Male home• General implementation• Resident level of involvement• Availability of meaningful activities• Medical conditions• Weather, transportation • Funding• Staff availability, motivation, and turnover  • Initial approach• Staff appreciation meals bimonthly for entire staff team • Goody bag with treats and compliments on staff effectiveness• Current approach• Individual gas cards• Monthly rewards in the children’s homes• Supervisor monthly rewards• Effective graded disciplinary strategy • Two-year expansion to four adult and five children’s homes• Repeated standardized process with tailored variations for each home • Individualized reinforcers and approach patterns• Activity preferences and timing• Structure of activities • Community outings• Small groups with distinct activities• Large groups with individual activitiesInitial HomeSocial OutingsLarge Group and individual activitiesSmall group activitiesHome Length of Program Percent MCSI Percent CIChildren Home 1 16 months 86.25% 79.88%Children Home 2 17 months 78.23% 78.00%Children Home 3 10 months 85.70% 84.70%Children Home 4 14 months 86.67% 83.08%Children Home 5 10 months 91.40% 85.70%Adult Home 1 7 months 85.50%Adult Home 2 31 months 79.10%Adult Home 3 6 months 90.26%Adult Home 4 31 months 73.33%MCSI = Meaningful Client and Staff InteractionsCI = Client Involvement81.4118.59Avg MCSINon-MCSI81.6618.34Avg CINon-CI1. 73-week maintenance and significant expansion were unique; shows long-term impact and viability2. Standardized program for institutions 3. Administrative top-down support and enthusiasm was evident; regulators impressed with program4. Development of new skills among direct care staff (internal and external observations)5. Quality of life significantly improved (children began implementing activities independently; residents took ownership of the program)

A Long-Term Leisure Program for Individuals with Intellectual Disabilities

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A Long-Term Leisure Program for Individuals with Intellectual Disabilities

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