Training support staff to embed teaching within natural routines of young children with disabilities in an inclusive preschool.

We evaluated a program for training 4 support staff to embed instruction within the existing activities of 5 children with disabilities in an inclusive preschool. The program involved classroom-based instruction, role playing, and feedback regarding how to effectively prompt, correct, and reinforce child behavior. Descriptions of naturally occurring teaching opportunities in which to use the teaching skills were also provided. Following classroom training, brief on-the-job training was provided to each staff member, followed by on-the-job feedback. Results indicated that each staff member increased her use of correct teaching procedures when training was implemented. Improvements in child performance accompanied each application of the staff training program. Results are discussed in terms of using effective staff training as one means of increasing the use of recommended intervention procedures in inclusive settings. Areas for future research could focus on training staff to embed other types of recommended practices within typical preschool routines involving children with disabilities.

Increasing one aspect of self-determination among adults with severe multiple disabilities in supported work.

We attempted to increase one aspect of self-determination among 3 supported workers with multiple disabilities. Following Baer's (1998) self-determination conceptualization, the workers were exposed to two conditions that involved working more versus less independently based on availability of assistive devices. Next, their condition preferences were assessed and honored. All participants consistently chose the more independent condition. Results reflect how self-determination may be enhanced by giving workers increased control over work situations.

Evaluating the functional utility of congregate day treatment activities for adults with severe disabilities.

Many adults with severe disabilities spend considerable amounts of time in segregated day programs. We evaluated the degree to which these programs support purposeful and age-appropriate activity. Observations in 100 congregate community and institutional program sites indicated that approximately half of consumer time was spent in purposeful activity, 75% of which was age-appropriate. In 20% of the sites, though, most activity was age-inappropriate. These results, which were similar across community and institutional settings, are discussed in terms of respective program administrators evaluating their supports through comparisons with activity involvement in other programs and the need for changes in programs providing primarily age-inappropriate activities.

Reducing job coach assistance for supported workers with severe multiple disabilities: an alternative off-site/on-site model.

Adults with severe multiple disabilities constitute a very small percentage of individuals in supported work. When these persons do obtain community jobs, considerable assistance is usually required. We evaluated an off-site/on-site program for reducing job coach assistance provided for three adults with severe multiple disabilities in a part-time community job. Following observations of the supported workers' job performance in a publishing company, the job support reduction program was implemented while the individuals received more traditional day services when not at work. The program involved assessing the amount and type of assistance provided for each step in a worker's job tasks, and then reducing the assistance through environmental adaptations and instruction. After implementation in the nonwork setting, the adaptations and instruction were extended to the work site. Immediate reductions occurred in the amount of assistance provided by job coaches for each supported worker while on the job. No adverse effects on productivity were observed. These results suggest that an off-site/on-site approach to reducing work assistance represents a viable alternative to current supported work models. Social validity observations in 10 job sites highlighted the need to demonstrate ways to reduce work assistance provided for workers with severe multiple disabilities. Future research areas are noted, focusing on evaluating other models for enhancing supported work opportunities for people with highly significant disabilities.

Embedded evaluation of preferences sampled from person-centered plans for people with profound multiple disabilities.

We investigated a brief, embedded assessment for evaluating preferences sampled from person-centered plans. After developing person-centered plans for individuals with multiple disabilities, systematic assessments were conducted with preferences sampled from the plans. An assessment of sampled preferences was then embedded within the participants' daily routines. The two assessments identified similar preferences based on participant approach responses. Both assessments also indicated inconsistencies with reported preferences in the person-centered plans. Overall, results suggested the embedded assessment may be an alternative means of evaluating some preferences reported through person-centered planning.

Reducing indices of unhappiness among individuals with profound multiple disabilities during therapeutic exercise routines.

A program was developed to reduce indices of unhappiness that accompanied therapeutic exercise routines among people with profound multiple disabilities. Indices of unhappiness were recorded, using an observation system that had been validated through previous research involving happiness-related variables, while support personnel conducted exercises with 3 participants. A multicomponent program was then implemented that involved presenting highly preferred stimuli before, during, and after each exercise session. Results indicated that the program was accompanied by reduced indices of unhappiness for each participant relative to the traditional method of conducting the exercises, although changes in the preferred stimuli used with 1 participant were required before consistent reductions occurred. Results are discussed regarding the importance of reducing unhappiness indices as a means of enhancing aspects of the daily quality of life for people with profound multiple disabilities. Areas for future research are also discussed, focusing on expanding the unhappiness-reduction procedures to other routine events that may occasion indices of unhappiness.

A behavioral approach to identifying sources of happiness and unhappiness among individuals with profound multiple disabilities.

This investigation evaluated a behavioral means of identifying sources of happiness and unhappiness among individuals with profound multiple disabilities. Indices of happiness and unhappiness were defined, and a corresponding observation system was developed and implemented with five students in an adult education classroom. Each student was observed while participating in two separate classroom activities. Results indicated the definitions and the observation system reliably identified different frequencies of happiness and/or unhappiness indices for each student across separate activities. Results are discussed regarding routine use of the observation system to evaluate classroom activities for effects on student happiness as a measure of quality of life. Future research needs are discussed in terms of determining means to alter certain classroom procedures that are accompanied by indices of student unhappiness.

A systematic evaluation of preferences identified through person-centered planning for people with profound multiple disabilities.

Person-centered planning is becoming a popular means of designing supports for people with disabilities. However, very little research evaluating person-centered planning exists. We evaluated the degree to which items and activities reported to be preferred in person-centered plans represented accurate preferences based on how individuals responded when presented with the items and activities. Person-centered planning meetings were conducted with 4 individuals with profound multiple disabilities to develop preference maps and to identify leisure-related preferences. A sample of the reported preferences in the plans was then systematically assessed by observing each participant's approach and avoidance responses to the items and activities. Of the sampled items and activities reported to be preferred in the plans, 42% represented moderate preferences based on the latter assessment process and 33% represented strong preferences. With 2 participants, several preferences identified in the plans were nonpreferred items and activities based on the preference assessments, and some were frequently avoided. These results suggested that although person-centered plans may identify some accurate preferences for people with profound multiple disabilities, this approach should be used cautiously. Results also suggested that such plans should be supplemented with systematic preference assessments to ensure the accuracy of identified preferences. Future research areas focus on evaluating other aspects of person-centered planning.

Supervisory training for teachers: multiple, long-term effects in an education program for adults with severe disabilities.

We evaluated a means of training special education teachers in supervisory strategies for improving specific teaching-related performances of their paraprofessional, teacher assistants. Using classroom-based instruction and on-the-job monitoring and feedback, seven teachers were trained to systematically observe the data collection and teaching performances of their assistants as well as to provide contingent feedback. The supervisory training for teachers, evaluated using a multiple-probe design across groups of assistants, was accompanied by improvements in data collection performances among seven of eight assistants. Improvement in other teaching skill applications also occurred. The improved performance among the assistants was maintained across a 17-month follow-up period. The supervisory training seemed to have multiple benefits in that the teachers' own teaching-related performances improved once teachers were trained to systematically observe and provide feedback to their assistants. The need for continued research is discussed to evaluate the benefits of supervisory training to improve and maintain other important areas of staff performance.

Identifying work preferences among individuals with severe multiple disabilities prior to beginning supported work.

We evaluated a prework assessment for predicting work-task preferences among workers with severe multiple disabilities prior to beginning supported work. The assessment involved comparing worker selections from pairs of work tasks drawn from their future job duties. Results of workers' choices once they began their jobs in a publishing company indicated that the assessment predicted tasks that the workers preferred to work on during their job routines. Results are discussed regarding other possible means of determining preferred types of supported work.

Increasing communicative interactions of young children with autism using a voice output communication aid and naturalistic teaching.

We evaluated the effects of a voice output communication aid (VOCA) and naturalistic teaching procedures on the communicative interactions of young children with autism. A teacher and three assistants were taught to use naturalistic teaching strategies to provide opportunities for VOCA use in the context of regularly occurring classroom routines. Naturalistic teaching procedures and VOCA use were introduced in multiple probe fashion across 4 children and two classroom routines (snack and play). As the procedures were implemented, all children showed increases in communicative interactions using VOCAs. Also, there was no apparent reductive effect of VOCA use within the naturalistic teaching paradigm on other communicative behaviors. Teachers' ratings of children's VOCA communication, as well as ratings of a person unfamiliar with the children, supported the contextual appropriateness of the VOCA. Probes likewise indicated that the children used the VOCAs for a variety of different messages including requests, yes and no responses, statements, and social comments. Results are discussed in regard to the potential benefits of a VOCA when combined with naturalistic teaching procedures. Future research needs are also discussed, focusing on more precise identification of the attributes of VOCA use for children with autism, as well as for their support personnel.

Assisting older adults with severe disabilities in expressing leisure preferences: a protocol for determining choice-making skills.

We evaluated a protocol involving two types of choice presentations for assessing leisure choice-making skills of seven older adults with severe disabilities. Initially when presented with pairs of objects representing choices, choice making was validated through demonstration of an object preference. A more complex choice-presentation format was then employed, involving pictures to represent choices. If the preference identified with objects was not demonstrated using pictures, a replication of the object format occurred to ensure changes in choice making using pictures was not due to a preference change. Five participants demonstrated choice-making skills using objects and two demonstrated choices using pictures. These results reflect the importance of assessing choice-making skills prior to presenting choice opportunities. Suggestions for future research focus on expanding the assessment protocol to include a wider array of choice-making skills and training staff to provide choices in a format commensurate with an individual's skill level.

Training basic teaching skills to community and institutional support staff for people with severe disabilities: a one-day program.

Shortcomings in the technology for training support staff in methods of teaching people with severe disabilities recently have resulted in calls to improve the technology. We evaluated a program for training basic teaching skills within one day. The program entailed classroom-based verbal and video instruction, practice, and feedback followed by on-the-job feedback. In Study I, four undergraduate interns participated in the program, and all four met the mastery criterion for teaching skills. Three teacher aides participated in Study 2, with results indicating that when the staff applied their newly acquired teaching skills, students with profound disabilities made progress in skill acquisition. Clinical replications occurred in Study 3, involving 17 staff in school classrooms, group homes, and an institution. Results of Studies 2 and 3 also indicated staff were accepting of the program and improved their verbal skills. Results are discussed regarding advantages of training staff in one day. Future research suggestions are offered, focusing on identifying means of rapidly training other teaching skills in order to develop the most effective, acceptable, and efficient technology for staff training.

Acquisition and functional use of voice output communication by persons with profound multiple disabilities.

The acquisition and subsequent functional use of communication skills by persons with profound mental and physical impairment using a voice output communication aid (VOCA) was evaluated. Initially, a graduated guidance and time delay procedure was used to teach three individuals to use a VOCA in response to a trainer's specific request. Results indicated that all participants increased their correct VOCA activations in response to specific requests following training. Probes also indicated that participants effectively used the VOCA after training to request preferred items in a variety of settings. The functional utility of VOCA skills was supported by a survey of individuals unfamiliar with the participants. This survey indicated that those surveyed could better understand the participants when they used a VOCA. Results are discussed as to potential advantages of VOCAs relative to other augmentative communication options for persons with multiple disabilities. Future research directions are discussed, focusing on strategies for promoting a broader set of communicative interactions using VOCAs.

Defining, validating, and increasing indices of happiness among people with profound multiple disabilities.

In this study we attempted to operationalize, measure, and increase happiness among people with profound disabilities. Happiness indices were defined and observed among 5 individuals. Validation measures indicated that (a) increases in happiness indices were observed when individuals were presented with most preferred stimuli relative to least preferred stimuli, (b) increases in unhappiness indices were observed when they were presented with least preferred relative to most preferred stimuli, and (c) practitioner ratings of participant happiness coincided with observed indices. Subsequently, classroom staff increased happiness indices through presentation and contingent withdrawal of activities. Results suggested that a behavioral approach can enhance happiness as one aspect of quality of life among people with profound disabilities. Research directions are offered that focus on using a behavioral approach to investigate other private events that are important among people with disabilities.

Comparing choice and questionnaire measures of the acceptability of a staff training procedure.

We compared questionnaire and choice measures of acceptability while evaluating effects of staff familiarity versus unfamiliarity with the system used to monitor performance during a training program. Staff members rated both monitoring formats equally favorably on the questionnaire, whereas when given a choice, they frequently chose the familiar format and never chose the unfamiliar format. These results suggest that traditional questionnaire evaluations may not be sufficiently sensitive measures of acceptability relative to choice measures.

Effects of a voice output communication aid on interactions between support personnel and an individual with multiple disabilities.

We evaluated a means of increasing staff members' interactions with an individual with multiple disabilities through use of a voice output communication aid (VOCA). When activated, the VOCA allowed the individual to communicate through synthesized speech. Results indicated that staff members interacted with the individual more frequently when she had access to the VOCA, suggesting that VOCAs may represent an alternative to more traditional staff management programs for increasing interactions.

Training residential supervisors to provide feedback for maintaining staff teaching skills with people who have severe disabilities.

We evaluated procedures for training supervisors in a residential setting to provide feedback for maintaining direct-service staff members ' teaching skills with people who have severe disabilities. Using classroom-based instruction and on-the-job observation and feedback, 10 supervisors were initially trained to implement teaching programs themselves. The training improved supervisors' teaching skills but was insufficient to improve the quality of feedback they provided to direct-service staff regarding the staff members' teaching skills. Subsequently, classroom-based instruction and on-the-job observation and feedback that targeted supervisors' feedback skills were provided. Following training in provision of feedback, all supervisors met criterion for providing feedback to their staff. Results also indicated that maintenance of teaching skills was greater for direct-service staff whose supervisors had received training in providing feedback relative to staff whose supervisors had not received such training. The need for analysis of other variables that affect maintenance of staff performance, as well as variables that affect other important areas of supervisor performance, is discussed.

Analyzing alertness among people with profound multiple disabilities: implications for provision of training.

We investigated whether variations in alertness among individuals with profound multiple disabilities affected subsequent responsiveness to training programs. Three experiments were conducted involving 5 people. In Experiment 1, results indicated that alertness of 3 individuals increased with provision of skill-acquisition training programs. Results also indicated no predictive relationship between alertness levels prior to training and subsequent responsiveness to training. Experiment 2 replicated results of Experiment 1 with 2 participants from Experiment 1 and an additional participant. Results of Experiment 2 also indicated that the increased alertness levels accompanying provision of training were not a function of the participants simply being in an inactive environment prior to training. Results of Experiment 3 indicated that alertness of an additional participant increased through provision of another training intervention, involving a systematic preference assessment. Responses during the preference assessment appeared to be unrelated to previously existing alertness levels. These findings suggest the need for caution when considering the withholding of scheduled training because an individual appears to be nonalert.

Evaluating and improving residential treatment during group leisure situations: a program replication and refinement.

The authors attempted to replicate and refine a program for evaluating and improving residential treatment services during group leisure periods in living units. In Study 1, an active treatment program was implemented using a consultant model in two living units serving persons with severe handicaps. Similar to previous research, the program was accompanied by decreases in nonadaptive client behavior in both units during leisure periods. In addition, a time-efficient monitoring system was developed which suggested that two staff-related variables, provision of leisure materials, and interactions with clients were related to the program's success. Study 2 evaluated more thoroughly the relationship of these variables to client nonadaptive behavior in 20 residential units in four states. Significant predictive relationships again were found between nonadaptive behavior and material availability, and between nonadaptive behavior and staff interactions with clients. Results of Study 2 also indicated that three living unit supervisors readily learned to use the evaluation system. Results are discussed regarding the importance of simple and efficient monitoring systems for routinely evaluating and improving residential services.