Programming Effective Human Services : Strategies for Institutional Change and Client Transition

Human service programming has been the focus of much public scrutiny, legislative action, and applied research in recent years. As a result, human service providers have learned to exhibit greater respect for the needs and legal rights of their consumers, the appropriateness and cost­ effectiveness of treatment procedures and service programs, and the per­ sonnel and facilities involved in providing services to consumers. Despite this encouraging trend, many human service agencies are still trying unsuccessfully to meet the two fundamental criteria of effec­ tive programming: (1) providing services that are effective in meeting the needs of the consumer and (2) equipping consumers to function indepen­ dently of the human service system to the extent possible. For example, there appears to be a general acceptance of the notion that custodial institutional service programs are needed, despite the fact that they are ineffective in rehabilitating and transitioning clients to the community and that they are difficult to change. In addition, although community­ based service programs have been developed as alternatives to institu­ tional placement, there is rarely sufficient transitional planning and pro­ gramming to facilitate the client's progress from the institution to the community. Although these problems generally are acknowledged, most human service managers and practitioners are ill equipped to deal with them. Specifically, the technology of human service management is in need of improvement. It is more theoretical than practical, and it lacks sufficient field testing and empirical validation.

The Right to Effective Human Service Programming.- 1. The Handicapped Are Citizens, Also.- 2. What Process Is Due?.- 3. The Liberty Interest.- 4. Legal Interventions.- 5. Segregated Self-Generating Programs.- 6. In What Environment Can Programs Be Effective?.- 7. Do Not Forget the Original Goal.- 8. The Right against Ineffective Programming.- I Programming Institutional Change.- 1 Promoting Change in Mental Retardation Facilities: Getting Services from the Paper to the People.- 1. Target Areas for Institutional Change.- 1.1. A Statement of Philosophy: The Client Is the Prime Center of Focus; All Decisions Must Be Based on the Welfare of Each.- 1.2. Prioritization of Goals.- 1.3. A Single Line of Supervision and Accountability.- 1.4. Reorienting Delivery of Services.- 1.5. Redefining the Role of Professionals.- 1.6. Staff Training.- 1.7. Staff Management.- 1.8. Quality Control.- 2. Summary.- 3. References.- 2 Behavioral Supervision: Methods of Improving Institutional Staff Performance.- 1. Development of the Behavioral Supervision Model.- 2. Basic Steps of the Behavioral Supervision Model.- 3. Evaluation of the Component Procedures of the Behavioral Supervision Model.- 3.1. Evaluation of Step 1: Behaviorally Defining Performance Areas.- 3.2. Evaluation of Step 2: Monitoring Performance.- 3.3. Evaluation of Step 3: Instructing.- 3.4. Evaluation of Step 4: Providing Consequences.- 3.5. Evaluation of Step 5: Evaluating.- 4. Research on Applications of the Behavioral Supervision Model.- 5. Problematic Concerns with the Behavioral Supervision Model.- 6. Summary.- 7. References.- 3 Implementing the Community-Based Teaching-Family Model at Boys Town.- 1. The Teaching-Family Model.- 1.1. Treatment Techniques.- 1.2. Based on Research.- 2. Boys Town: An Overview of the Organization in 1975.- 2.1. Social Change and the 1970s.- 2.2. The Team Approach.- 2.3. Institutional Living.- 2.4. New Directions.- 3. From Community to Institution.- 3.1. Resource Availability.- 3.2. Change Agents.- 3.3. Resistances to Change.- 3.4. Planning and Managing Change.- 3.5. Maintaining a Change Orientation.- 3.6. Results of Change.- 4. Evaluating the Change.- 5. After the Change.- 6. References.- 4 The Effects of Institutional Change: A Case Study.- 1. Programming Institutional Change.- 1.1. Program Status Prior to Institutional Change.- 1.2. Methodology of Institutional Change.- 2. The Effects of Institutional Change.- 2.1. Funding.- 2.2. Staffing.- 2.3. Service Delivery.- 2.4. Legal Safety.- 2.5. Public Relations.- 3. Summary and Discussion.- 4. References.- II Facilitating Client Transition to the Community.- 5 The Community-Based Service Continuum.- 1. The Continuum of Care.- 2. Historical Review of Continua Changes.- 2.1. Mentally Ill.- 2.2. Mentally Retarded.- 2.3. Juvenile Offenders.- 3. Key Issues in the 1980s.- 3.1. Policymaking and System Planning.- 3.2. Funding.- 3.3. Effectiveness.- 4. Summary.- 5. References.- 6 Assessing the Client’s Readiness for Transition to the Community.- 1. Development of the Assessment Instrument.- 2. Implementation.- 3. Results and Discussion.- 4. Implications for Human Service Programming.- 5. Summary.- 6. References.- 7 Preparing the Client for Transition to the Community.- 1. Clients in Need of Residential Treatment.- 2. Systems for Advocacy.- 2.1. Family Advocate.- 2.2. Social Services or Legal Advocate.- 2.3. Agency Advocate.- 3. Essential Skills for Community Transition.- 3.1. Where to Find Essential Community Skills.- 3.2. Conflicting Priorities.- 3.3. Confirming and Disseminating the Priorities.- 4. Systematic Changes in Behavior.- 4.1. Determining Change Strategies and Therapist Notification.- 5. Arranging the Training Environment.- 5.1. Programming Common Stimuli.- 5.2. Training with Sufficient Examples.- 5.3. Training Loosely.- 5.4. Making the Contingencies Indiscriminable.- 5.5. Introducing Naturally Maintaining Contingencies.- 6. Preparing the Future Environment.- 7. Summary.- 8. References.- 8 Preparing the Family for Client Transition: Outreach Parent Training.- 1. Issues and Strategies in Outreach Parent Training.- 1.1. Rationale.- 1.2. Methodology.- 2. A Case Study in Outreach Parent Training.- 2.1. Setting.- 2.2. Participants.- 2.3. Objectives.- 2.4. Procedures.- 2.5. Outcome Measures.- 2.6. Results.- 2.7. Discussion.- 3. Summary and Discussion.- 4. References.- 9 Preparing Public School Teachers for Client Transition.- 1. Professional Involvement in Client Transition and Teacher Training.- 1.1. Training Procedures.- 1.2. Group Instructional Procedures.- 1.3. Integration into Normal Classrooms.- 1.4. Teacher Motivation and Attitudes.- 2. Special Learning Characteristics.- 2.1. Physically Disruptive Behavior.- 2.2. Self-Stimulatory Behavior.- 2.3. Stimulus Overselectivity.- 2.4. Lack of Motivation.- 3. Curriculum Development.- 3.1. Assessment.- 3.2. Curriculum Development.- 4. Generalization of Treatment Gains.- 4.1. Stimulus Generalization.- 4.2. Response Generalization.- 4.3. Generalization over Time.- 5. Methods of Facilitating Generalization.- 5.1. A Natural Language Paradigm of Treatment Delivery.- 5.2. Delay of Consequences.- 6. Conclusion.- 7. References.- 10 Transitioning Severely Handicapped Children Back to Public Schools.- 1. The Concept of the Least-Restrictive Environment.- 1.1. Legal Requirements Regarding Educational Placements.- 1.2. The Legal Requirements and Deinstitutionalization.- 2. Transitioning Begins at Initial Referral.- 2.1. Prevention of Inappropriate Admissions.- 2.2. Formalizing Transition Plans.- 3. Assessment of the Receiving Class.- 3.1. Crucial Skill Domains.- 4. Preparing the Child.- 4.1. Redesigning the Curriculum.- 4.2. Preparing the Child for Group Instruction.- 5. Preparing the Receiving Class.- 5.1. Peers as Models.- 5.2. Peers as Tutors.- 5.3. Peers as Behavior-Change Agents.- 6. Conclusion.- 7. References.- 11 Treatment Strategies That Promote Deinstitutionalization of Chronic Mental Patients.- 1. Factors Associated with Successful Deinstitutionalization.- 2. Model Programs for Deinstitutionalization.- 2.1. Institutional Psychosocial Treatment.- 2.2. Day Treatment Services.- 2.3. Family-Management Training to Prevent Relapse.- 3. Summary.- 4. References.- 12 State-Level Coordination of the Transition from Institution-Based to Community-Based Services.- 1. Factors Impeding the Transition.- 1.1. State Government Factors.- 1.2. Personnel Factors.- 1.3. Fiscal Factors.- 1.4. Regulatory Factors.- 2. Factors Affecting Coordination of the Transition.- 2.1. Prerequisites.- 2.2. State and Community Planning.- 2.3. Program Development.- 3. The Future Role of Institution-Based Services.- 4. The State’s Role in the Transition.- 5. Conclusion.- 6. References.- III Promoting Maintenance of Client Transition.- 13 Training Parents as Therapists for Autistic Children: Rationale, Techniques, and Results.- 1. Autism.- 2. Parent Training.- 3. The Claremont McKenna College/University of California at Santa Barbara Parent-Training Program.- 3.1. Measures.- 3.2. Training Procedures and Target Behaviors.- 3.3. Consequences.- 3.4. Results and Discussion.- 4. References.- 14 The Independent Living Movement: A Model for Community Integration of Persons with Disabilities.- 1. The Independent Living Movement.- 2. Independent Living Centers and Services.- 3. Cooperative Strategies for Promoting Community Change.- 3.1. Identifying Community Concerns.- 3.2. Identifying Resources for Community Change.- 3.3. Organizing Resources for Change: Building Coalitions.- 3.4. Mobilizing Resources for Community Change.- 4. Summary and Discussion.- 4.1. A Reasonable History?.- 5. References.- 15 Day Treatment Services for Children with Severe Behavior Disorders.- 1. A Model Day Treatment Program.- 2. Developing a Model Program.- 2.1. Rationale.- 2.2. System Management.- 2.3. System Activities.- 3. Service Programming.- 3.1. Therapeutic Services.- 3.2. Educational Services.- 3.3. Recreational Services.- 3.4. Family Education and Support Services.- 3.5. Early Intervention.- 4. Evaluation.- 4.1. Product Evaluation.- 4.2. Process Evaluation.- 5. The Importance of Public Support.- 5.1. The Family.- 5.2. The Community.- 5.3. Professional Involvement.- 5.4. Referring Agencies.- 6. Summary.- 7. References.- 16 Careprovider and Respite Care Services.- 1. Training Services for Careproviders.- 2. Careprovider Training Program.- 3. Careproviders.- 3.1. Meeting the Needs of Trainees: Three Levels of Service Delivery.- 4. Training Curriculum.- 4.1. Initial Training.- 4.2. In-Home Training.- 4.3. Ongoing Training.- 5. Modifications for Moderate and Specialized Careproviders.- 5.1. Modified Curriculum.- 5.2. Additional Training for Respite Care Workers and Ancillary Therapists.- 6. Implementing a Respite Care Program.- 7. Proposal for Incorporating Respite Care Services into the Transitional Teaching Homes Model.- 7.1. Out-of-Home Respite Care.- 8. Outcome.- 9. Discussion.- 10. Recommendations.- 10.1. A Proposal for a Treatment Accountability System.- 11. References.- 17 Teaching-Family Model for Autistic Children.- 1. Teaching-Family Model for Autistic Children.- 1.1. Program Parameters.- 1.2. The Children.- 1.3. Workshop Training for Teaching Parents.- 1.4. Consultation.- 1.5. Evaluation.- 2. Discussion and Summary.- 3. References.- 18 Transitional Teaching Homes for Developmentally Disabled Clients.- 1. Rationale for Transitional Teaching Homes Concept.- 2. History of the Transitional Teaching Homes Concept.- 2.1. The Teaching-Family Model: “Achievement Place”.- 2.2. Transitional Teaching Home Model.- 2.3. Camarillo Teaching Homes Project.- 2.4. Green Line Teaching Homes, Inc..- 3. Components of Transitional Teaching Homes.- 3.1. Physical Plant Considerations.- 3.2. Board of Directors.- 3.3. Staff Composition.- 4. Staff Training.- 4.1. Training Consultants.- 4.2. Teaching Parents.- 5. Staff Incentives.- 5.1. Competency-Based Promotional System.- 5.2. Longevity Bonuses for Weekday Teaching Parents.- 5.3. Staff Exchange Program.- 6. Clients.- 6.1. Individual Treatment Program.- 7. Program Evaluation and Conclusions.- 7.1. Camarillo Teaching Homes Project.- 7.2. Green Line Teaching Homes, Inc..- 7.3. Cost-Effectiveness.- 8. Summary.- 9. References.- 19 Short-Term Intensive Services: A Deficit-Oriented, Focused Model.- 1. Philosophy of Instruction.- 1.1. Background.- 1.2. Curriculum Content.- 1.3. Prioritized Goals.- 1.4. Sequential versus Simultaneous Intervention.- 1.5. Parallel Programming.- 1.6. Intensive Service Delivery.- 1.7. Time Limited.- 2. Organizational Structure.- 2.1. Rationale.- 2.2. Curriculum and Program Development.- 2.3. Individualized Goal Plan (IGP).- 2.4. Child Groupings.- 2.5. Staff Organization.- 3. Utilization of Advanced Technology.- 3.1. On-line System.- 3.2. Child Evaluation.- 3.3. Child Progress Analysis.- 3.4. Data Collection, Analysis, and Miscellaneous Functions.- 3.5. Direct Instruction.- 4. Conclusion.- 5. References.- 20 Community-Based Residential Treatment for Autistic, Developmentally Disabled, and Predelinquent Children: The CIRT Model.- 1. Background.- 2. CIRT Parameters.- 2.1. Admission Criteria and Client Population.- 2.2. Lengthening the Treatment Schedule.- 2.3. Client Characteristics.- 2.4. SOAPOing as a Tool of Staff Training, Management, and Accountability.- 2.5. Increasing the Amount of Structured Treatment.- 2.6. Types of Treatment Programs.- 2.7. Staff Organization.- 2.8. Program Monitoring.- 3. Outcome Data.- 3.1. Number of Clients Treated and Length of Stay.- 3.2. Behavioral Improvement.- 3.3. Acquisition of Skills by the Autistic/DD Group.- 3.4. Academic Progress of the EH Group.- 3.5. Parent Training.- 3.6. Staff Turnover Rate and Length of Stay.- 4. Cost Analysis.- 5. Follow-up.- 5.1. Placement.- 5.2. Learning Progress.- 5.3. Behavioral Problems.- 5.4. Program Adoption by Families and Schools.- 6. Training and Dissemination.- 7. General Discussion.- 8. References.- Author Index.