R. Mark Mathews

A contextual-behavioral model of empowerment: case studies involving people with physical disabilities.

When people with disabilities, ethnic minorities, older adults, women, and others lack power, they usually experience adverse conditions disproportionate to other members of society. Emproverment—the process by which people gain some control over valued events, outcomes, and resources—is an important construct for understanding and improving the lives of people of marginal status. This manuscript presents a contextual-behavioral model of empowerment and its application in collaborative research with people with physical disabilities. The eight case studies illustrate 18 tactics for promoting empowerment that flow from the model. The case studies show the use of different combinations of empowerment tactics in a variety of contexts: (a) setting improvement agendas from the perspective of people with disabilities, (b) enforcing ordinances that preserve access to parking spaces designated for people with disabilities, (c) enabling access to homes through housing modifications, (d) enhancing support available through mutual-aid groups, (e) developing skills for recruiting mentors, (f) promoting self-directed behavior hange with personal and health concerns, (g) enhancing skills for personal self-advocacy, and (h) building the capacities of groups of people with disabilities for systems advocacy. Finally, we discuss issues that may contribute to research and action related to empowerment.

Keeping the beat: Use of rhythmic music during exercise activities for the elderly with dementia

Involving people with dementia in group exercise activities often presents a challenge. The effects of a recorded instrumental musical accompaniment was evaluated on participation in a series of 14 exercise activities with a group of nursing home residents with dementia. All exercise sessions, specifically designed by physical therapists for older adults, were lead by an activity aide and consisted of a series of seated exercises. Direct observations of resident behavior were conducted over a 25-week period in a reversal experimental design. Results showed increased levels of participation during the experimental condition observations where rhythmic music accompanied the exercise activities. The music intervention was most successful on those generally most willing to participate in social activities.

Restoring dressing independence in persons with Alzheimer's disease: A pilot study:

Purpose: Well meaning nursing facility staff may compromise the independence of older adults with dementia by performing activities of daily living for residents. We assessed the impact of teaching certified nursing assistants (CNAs) to use a graduated prompting procedure to increase dressing independence of persons with dementia. Design and methods: This study was conducted in a seven-bed dementia care unit. Three residents and two CNAs participated in the study. We used a repeatedmeasures experimental design to evaluate the effect of a training workshop for CNAs on a strategy for increasing resident engagement in self-care activities. Results: During a series of baseline observations, we found that CNAs typically dressed residents with minimal resident involvement. Results showed that, following the training workshop for CNAs, resident independence in dressing increased and range of motion improved. Implications: CNAs can provide restorative care that increases dressing independence and range of motion of older adults with dementia.

Assessment of active music participation as an indication of subsequent music making engagement for persons with midstage dementia

Persons with midstage dementia and in special care (N = 45) were assessed in groups by a music therapy practitioner to determine the level of engagement in a 15-minute protocol that included a five-minute segment for each of three music activity types—rhythm playing, exercising with music, and singing. Activity staff with little to no formal music training who were employed by the facility were taught to use the protocol to conduct eight subsequent activity sessions for small groups from which activity engagement data were collected for each subject. Results indicated the protocol was accessible and successful for indigenous activity staff, initial assessments were strong predictors of subsequent engagement, and participation levels were stable over time and across each of the three activities.

Enhancing leadership skills for community self-help organizations through behavioral instruction.

Group members with skills to lead effective meetings are valuable resources of any community organization. The effects of a behaviorally based textbook and training procedures designed to teach members of community self-help groups to chair effective meetings were analyzed. Measures were collected during regularly scheduled meetings on chairperson performance, member participation, and the closure of discussion topics. The results showed that the use of specified chairperson activities increased after training for each of two chairperson trainees. Further, outcome data suggest that more decisions were made. These findings suggest that the chairperson training procedures may enhance the leadership and decision-making resources of community self-help groups.

Facilitating Resident Information Seeking Regarding Meals in a Special Care Unit: AN ENVIRONMENTAL DESIGN INTERVENTION

Repetitive questions and requests for information are common in older adults with dementia. The purpose of this environmental design intervention was to provide residents continuous access to information about common mealtime questions with the intent of decreasing agitation around mealtimes and facilitating more pleasant patient-staff and patient-patient interactions. A special care unit for residents with dementia of the Alzheimers type was the setting. During the intervention conditions, a large clock and a sign with large lettering that identified mealtimes were hung in the dining area. Direct observations of 35 residents were conducted at mealtimes for a 5-month period. Results showed reductions from baseline to the intervention phase in food-related questions or requests. These results suggest a simple, inexpensive environmental change intervention can reduce repetitive questions commonly exhibited by individuals with dementia.

Finding a practical method to increase engagement of residents on a dementia care unit

Previous research has shown that it is possible to increase the engagement of residents with dementia in daily activities by making changes in institutional care practices. However, these changes often require expensive and cumbersome staff training programs that longterm care facilities may be unlikely to adopt and maintain. This study evaluates a simple, inexpensive recording and feedback procedure to increase resident engagement in a way that may be more amenable to adoption by long-term care facilities. Nursing assistants working in a locked dementia care unit were asked to complete a daily activity record on which they recorded the amount and quality of resident engagement. The facilitys activity director was asked to read these activity records each day and give immediate, positive feedback to the nursing assistants. This procedure was evaluated by using a control series design. Results revealed baseline engagement observations with a mean of 11 percent, which increased to a mean of 44 percent during observations under treatment conditions. This study suggests that simple, inexpensive changes in institutional practices can make meaningful improvements in the level of engagement of residents with dementia.

Behavior Analysis and Public Policy

The Task Force on Public Policy was created to examine ways for behavior analysts to be more functional citizen scientists in the policymaking arena. This report informs readers about the contexts and processes of policymaking; and it outlines issues regarding the roles of behavior analysts in creating policy-relevant conceptual analyses, generating research data, and communicating policy-relevant information. We also discuss a possible role for the professional association in enhancing analysis, research, and advocacy on policies relevant to the public interest.

Brief In-Service Training in Music Therapy for Activity Aides: Increasing Engagement of Persons with Dementia in Rhythm Activities

Abstract This study analyzed the effects of a brief in-service training workshop designed to teach activity aides how to use music therapy techniques. Sixteen persons with dementia, living in a nursing home special care unit, served as the research participants. Results showed that training conducted with activity aides significantly increased resident engagement with rhythm instruments in both one-on-one interactions and in group activity situations. Similar increases were observed in residents with a range of cognitive impairments. These results suggest that this intervention offers a potentially promising approach that indigenous staff can use to engage residents with dementia in purposeful activities.

Assessing Dissemination Capability An Evaluation of an Exportable Training Package

Disseminating packaged behavioral intervention programs appears to be an increasingly important objective in the field of applied behavior analysis. An exportable training package, designed to teach helping skills to community service workers, was evaluated with two social service agencies. The package was mailed to a community proctor who administered the materials without direct instructional contact with the experimenters. The results showed that the percentage of specified trainee target behaviors increased after the training package was introduced. Ratings of trainee performance by independent community service workers correlated with behavior observations of trainee performance. This study illustrates a method for assessing the effectiveness of behavioral interventions to be disseminated to potential consumers.