Ursula de Kock

An eco-behavioral analysis of small community-based houses and traditional large hospitals for severely and profoundly mentally handicapped adults

Recently, much interest has centered on the transfer of mentally handicapped people from institutions to other settings. Most studies in this area have focused indirectly on the behavior of the mentally retarded client, usually measured intermittently by global assessments such as the American Association On Mental Deficiencys Adaptive Behavior Scale. In contrast, the present study combined these indirect measures with direct continuous observation of each subject. In doing so, it examined the effects of such a transfer to small community-based homes on the behavioral functioning of severely and profoundly mentally handicapped adults. In addition, staff activity, in terms both of providing opportunities for engagement in activity and of consequating client behavior, was also measured. Two comparisons were made, those being between a group of clients in a small home and a comparable group in institutions and between the latter group when in the institutions and after having moved to a small home. Results show increased client functioning in the small homes, particularly in domestic activity and interaction with staff, and a markedly higher level of staff provision of opportunity to engage in activities. The results are discussed in terms of size, design, staff-client ratio, and staff training in small community-based residential services. The need for more research on the determination of staff performances is highlighted.

Increasing purposeful activity of severely and profoundly mentally-handicapped adults☆

Abstract A time-series reversal design was used to evaluate the effect of a ‘room manager’ procedure on the level of purposeful activity of severely and profoundly mentally-handicapped people in a residential home. The room manager procedure consisted of systematic prompts to participate in recreational activity and social reinforcement contingent on engagement. Data were collected on group and individual client behaviour and two measures of staff performance were taken to assess whether the procedure was implemented consistently across subjects and in line with the experimental design. The results showed that, as well as a group of subjects who engaged at a higher level during the room manager condition, there were consistently ‘high-engaging’ and ‘low-engaging’ groups, reflecting in part the general level of ability of the subjects. However, data on the independent variables show that the the contingency of staff contact did not vary across conditions and it cannot therefore be assumed that these subjects would not respond to the intervention. Some limitations of the procedure as used are discussed, and areas where further work is needed are indicated.

Observational studies of staff working with mentally retarded persons: A review

Experimental or quasi-experimental studies of the behavior of staff working with retarded persons were reviewed and provided the following generalizations: (a) staff often have very low rates of interactions with clients, (b) a disproportionate number of interactions occur with a relatively small number of clients, (c) structured settings promote more interactions, (d) small teaching groups promote interactions, (e) staff involvement in relevant decisions promotes interactions, (f) larger, more global, and ecological assessments of both staff and clients provide important information on the effects of staff management and training, (g) lowering the reading difficulty of training materials increases staff comprehension, (h) lectures tend to improve academic skills while practicum training improves teaching skills, (i) some trained skills generalize while others do not, apparently unsystematically, (j) a system in which supervisors rather than researchers external to the facility do the training is feasible, (k) various low cost systems of public or private feedback can increase staff participation in their duties, (l) implementation of strict administrative policies can reduce tardiness and absenteeism, and (m) staff may be very reactive to announced observation by inspection agencies.

Measuring the activity of severely and profoundly mentally-handicapped adults in ordinary housing

Earlier work on the quality of care in settings for severely and profoundly mentally-handicapped adults raised the question whether any useful purpose is served by promoting the extensive use of simple recreational materials to occupy people. Data were collected by direct observation on the activity of 6 adults living in a staffed house organized to promote engagement in household activities. Observations were taken over 5 weekdays from 07.00 to 10.00 and 15.00 to 23.00hr. The results showed that Ss spent between 22 and 67% of available time in purposeful activity. Between 27 and 65% of purposeful activity was engagement in domestic or housework tasks. Even the most handicapped people spent more time engaged in housework than in leisure and recreational tasks. The implications of these data are commented on and measurement issues which arise in ordinary housing as opposed to institutional settings are discussed.

An ecological comparison of small community-based houses and traditional institutions--II. Physical setting and the use of opportunities.

Abstract The effects of transferring severely and profoundly mentally-handicapped adults from institutional to community care and the use made of the physical setting were examined. The material enrichment of two small homes in the community and six institutional settings was assessed and the use made of each type of item in the environment was observationally measured. Two comparisons were made: (a) between an experimental group of six people in a small home and a comparable control group, of which one member lived in each of the six institutions; and (b) between the latter group both when in institutions and following transfer to a small home. The inventories of the physical environment showed an increased level of opportunity in the small homes due to the considerably greater presence of and access to equipment and materials. Residents of the small homes demonstrated a greater range and extent of usage of the physical setting than the institutional group. The type of materials significant in the difference and the implications for the value of institutional adaption are discussed.

Providing systematic individual teaching for severely disturbed and profoundly mentally-handicapped adults in residential care

An organizational system for providing individualized behavioural teaching to severely and profoundly mentally-handicapped adults was developed by adapting the materials and procedures used in the Portage model of domiciliary teaching. Implementation of the system following a short training workshop was monitored in four residential units in turn over a 3-month period. The progress of each of 6 severely and profoundly mentally-handicapped adults in each unit was assessed on a defined task before and subsequent to teaching using a multiple time-series design. Little skill acquisition was found and the results are contrasted with evaluations of Portage services to pre-school mentally-handicapped children. Methodological considerations in the evaluation of progress in profoundly mentally-handicapped adults are raised.

Establishing appropriate mealtime behaviour of a severely disruptive mentally handicapped woman

A profoundly mentally handicapped woman was reported to be a major management problem for staff in the residential home where she lived, especially at mealtimes. Following a constructional approach the subjects appropriate behaviour was targeted. A multiple baseline design with reversal was used to investigate the effects of a contingent contact procedure on the subjects level of engagement. Results showed the procedure to be effective in increasing the amount of time the subject spent engaged in appropriate mealtime behaviour. Continuing problem behaviour at other times of day is discussed within the context of the overall living environment.