Increasing Independence Within Adult Services: a Program for Reducing Staff Completion of Daily Routines for Consumers with Developmental Disabilities

Consumers of services provided by a number of behavior analysts include adults with developmental disabilities. A survey by the Association of Professional Behavior Analysts indicated that approximately one third of their membership respondents work with this consumer population (APBA 2009). Although behavior analysts work with adults who have developmental disabilities in a variety of settings, one of the most common is congregate or center-based day programs. Center-based programs (e.g., day habilitation facilities, sheltered workshops) represent the most common day service setting for adults with developmental disabilities despite a current philosophical and professional emphasis on promoting more community-integrated services such as supported employment (Wehman 2011). The number of center-based programs also has been increasing in recent years (Dague 2012). Center-based, adult day programs are intended to provide a variety of services such as vocational training, paid work opportunities (e.g., sheltered work tasks), leisure activities, and general skills training. Across the various services, a fundamental purpose is to enhance independent functioning among the adult consumers (Parsons et al. 2008). However, these settings have received noted criticism concerning the quality of services provided (Cimera 2011; Dague 2012; Wehman et al. 2001) and specifically due to ineffectiveness in actually promoting consumer independence (Parsons et al. 2008). The recent increase in behavior analyst practitioners around the USA (Critchfield 2011) could represent a significant opportunity to improve the degree to which consumer independence is promoted in adult services. Although there has been a relative lack of behavioral research in adult day programs (Parsons et al. 2004), and especially compared to other settings (e.g., schools) and populations (e.g., children with disabilities), the research that has occurred suggests that behavior analysts have much to offer. To illustrate, recent applications of behavior analysis technology within adult day programs have demonstrated effective means of training skills for working productively in community jobs (Lattimore et al. 2008), participating in age-appropriate leisure activities (Jerome et al. 2007), and acquiring daily living skills (Parsons et al. 2008). For behavior analysts who work with adult day programs and strive to help promote consumer independence, a common occurrence within these programs may warrant special attention. Specifically, staff in adult services are often observed to perform important tasks for agency consumers in contrast to teaching or otherwise encouraging the consumers to perform the tasks themselves. Observations of work activities in center-based programs have indicated, for example, that staff frequently complete a major portion of the tasks that adults with severe disabilities are expected and paid to complete (Parsons et al. 2001). Agency staff likewise often perform routine activities of daily living for consumers (Felce et al. 2002). One explanation why staff perform necessary tasks for individuals with developmental disabilities in contrast to teaching or encouraging consumers to perform the tasks is that staff believe it is easier and less time consuming to complete the tasks themselves (Guess et al. 2008). Despite this and other potential explanations, there is general agreement that when staff perform necessary tasks for people with developmental disabilities, individual growth and development is impeded (Guess et al. 2008). Relatedly, a learned helplessness phenomenon is considered to result that encourages general passivity and dependence (Cannella-Malone et al. 2011; Felce et al. 2002). In light of concerns with promoting consumer independence in adult services, we have been engaged in applied research on ways to enhance the independent functioning of adults with developmental disabilities in day program settings. To date, our research has focused on training agency staff how to carry out individualized teaching procedures (e.g., Parsons et al. 2013), design job tasks to promote independent work (Parsons et al. 1999; Parsons et al. 2002), and prompt and reinforce engagement in scheduled activities (Parsons et al. 2004). In conducting such research, as well as performing normative observations in adult day programs in a number of states (Reid et al. 2001), we have observed one particular situation in which staff frequently perform tasks for individual consumers that has not been specifically addressed: routine, transition-related activities. That is, there appears to be a common tendency for staff to perform tasks for consumers during activities that represent transitions between formal instruction and/or paid work duties (e.g., when one work task is completed and materials are replaced for a new work task, preparations are made for consumers to enter or leave an activity site, during snack and break times). Consequently, an additional means of promoting consumer independence in adult services would be to reduce staff completion of transition-related routines and increasing consumer completion of the activities. The purpose of this investigation was to evaluate a systematic approach for reducing staff completion of routine, transition-related activities for adults in a day program. The goal was to demonstrate a practical process that behavior analysts could apply when working with adult services to further promote independence among adults with developmental disabilities.