Introduction to Active Treatment

Objectives:

At the end of this unit participants will be able to:

1.Know and understand the basic concepts of Active Treatment

2. Assess the quality of Active Treatment within their program

3. Implement the conditions of Active Treatment within their program

Active Treatment - The Basics

ACTIVE TREATMENT IS KEY TO QUALITY PROGRAMS AND SERVICES!

Active Treatment is:

AGGRESSIVE in implementation! Staff is always actively seeking ways to implement the treatment program.

CONTINUOUS (all the time!) Staff on different shifts and on different days will implement the program in the same way using the IPP plans (Individual Program Plan) at every appropriate opportunity.

Training that occurs at the appropriate time (normal) and in the appropriate place.

Active Treatment Promotes Independence!

Active Treatment prevents deterioration of medical conditions and personal skill development.

“Active Treatment is what we offer that makes our services specialized and better than those offered by the typical "medical model".

AGGRESSIVE, CONTINUOUS ACTIVE TREATMENT IS OUR PRIORITY!

Active Treatment means an aggressive and organized effort to maximize each client's fullest developmental potential. It requires an integrated, individually tailored plan of services directed to achieving measurable, behaviorally stated objectives. It requires an environment approximating everyday life in mainstream society. The goal is the development of those skills, behaviors, and attitudes essential to independent living in contemporary society.

Almost every aspect of a daily routine can become a setting for skill training. For those we serve, even the most basic tasks, such as personal care, home management tasks, social interactions, and even leisure activities may be difficult to master. For many, repeated reinforcement of these skills in their natural setting will be the only way to ensure their development. Learning difficulties may slow the process of learning such activities, but this does not necessarily mean that they can never be learned. For this reason, most state agencies overseeing training-oriented programs insist that there be little “down time”. Unstructured periods in many program guidelines “are not to exceed two (2) hours of a client’s waking day”.

While not everyone may achieve a level of total independence, it is known that all persons, regardless of the severity of their condition, can grow, change, and respond to some degree. In each individual instance it can never truly be known how much that person may ultimately achieve. Therefore, legally and ethically, active treatment is the approach we must always take in providing services. This must be done in a manner that is the least restrictive and in the most normalized manner. This allows each individual receiving our assistance to progress to his or her utmost!

Questions to Pose in Planning and Providing Active Treatment

1. How can we address the active treatment needs of individuals along their full life span?

2. Is the activity part of a routine, scheduled, or planned?

3. Are materials present to implement all planned activities?

4. Are these materials being used? If not, why not?

5. What is your consumer's response to the activity? Are they participating, observing, or uninvolved?

6. Are activities and materials age-appropriate, adaptive, and functional?

7. Are new skills being taught or reinforced?

8. Is the individual being encouraged, reinforced, and prompted frequently enough to maintain some level of participation?

9. Are all staff persons physically and verbally involved as a part of the activity?

10. Are there sufficient staff members for the activity to take place?

11. Are interactions characterized by a "mentor/friend" tone on the part of staff?

12. Does the activity relate directly to an identified objective or need?

13. Are available staff persons properly trained to provide needed supervision and familiar with program training techniques?

14. Are available staff members properly trained to deal with identified behavioral issues, (e.g., aggressive and self-injurious behaviors, self-stimulation, inappropriate social behaviors, etc.)?

Answering these questions gives us a good overview of what it takes to provide Active Treatment. As you can see, it will take a great deal of planning to make it happen. This planning process involves a team effort in most cases. You will be working with the person you are providing care for, as well as, their support group. By looking at long and short-term needs, it is possible to develop a list of prioritized goals. These goals are further broken down into objectives, which become the guidelines for the training. Information in the Individual Service

Plan will include how, when, where, and what to use in the training process.

It is very important that any potential problems, such as broken equipment or transportation problems be dealt with right away. In most programs, agencies overseeing this process will not tolerate "gaps in services". They will stress your agencies agreement to provide continuous services and may consider removing clients from your program or withholding funding.

Similarly, if you, or other staff, are not following the proper guidelines when you provide training, this is considered unprofessional. If you have any difficulty in following the instructions provided for training exercises contact a supervisor at once. Likewise, if you are working with others that are not using the same training techniques as you, this inconsistency will cause problems and will affect the outcome of the process. Again, do not hesitate to communicate these concerns with your coworkers and, if necessary, your supervisor.

Making Active Treatment Happen

It is your agency's responsibility to provide Active Treatment for each of your clients. When a new person enrolls in a service/program, this begins an ongoing process to determine how and what training needs will be addressed. The following are the basic steps used in this process:

1. Identifying training needs of the client in the area of Individual Critical Skills

Our task is to provide training in Individual Critical Skills. Individual Critical Skills are those relevant, essential skills that are thought to be important by all significant people in the client's life and that will increase their participation in chronologically age-appropriate activities in present and future natural environments.

The following is a list of ten reasons for selecting particular skills to be taught:

1. Functionality:

We teach functional skills. Functionality refers to an action that may be performed by any person that enables them to be involved in routine life activities. The individual who uses functional skills may or may not understand all of the ins and outs of the process, but can engage in the process nonetheless. An example would be our use of a computer. We may not know how it works but with basic training we may be able to send emails over the Internet. Likewise, a person with a severe intellectual disability may not understand the value of money but could learn to put coins in a machine to buy a soda.

2. Chronologically Age-Appropriate:

This refers to skills, attitude, instructional materials, environments and activities that are associated within a particular age group. Skills appropriate to the individual's age group should be taught in order to give them a better chance for a dignified lifestyle. For example, in order to increase a person's ability to blend into his or her social group, it is important that they are dressed similarly to their peers. The skills that we teach should similarly allow for the greatest possible interaction of our clients within the community.

3. Increases The Number of Environments:

The more skills an individual learns the more environments they can function in effectively. It is important that we understand that people with mental retardation may have a difficult time learning skills outside of their naturally occurring settings. That is to say, if we are going to teach someone to shop at a market, we must teach those skills within the market they may be frequently using. The more opportunities we can provide for them to learn within the natural environment, the greater their chances are of successfully using those settings.

4. Required In Adulthood:

Adult clients should be taught skills that are commonly used by adults. The goal is a normalized lifestyle. If we only provide activities that seem to fit the person's mental age, such as coloring in a coloring book, we are doing the person a disservice. Alternative activities, such as simple adult-oriented craft projects will allow for more interaction with non-disabled peers.

5. Individual Preferences:

Participation in the skill selection process increases the likelihood of effort on the part of that person to learn the skills. Assessing individual likes and dislikes is an important part of this process.

6. Parent/Guardian Preferences:

Parent/Guardian involvement in the planning process is often critical to its success. Family members can provide a great deal of insight into personal preferences, as well as, helping to prioritize goals that will support them in their care or general interaction with the individual receiving services.

7. Physical Enhancement:

Physical Enhancement refers to selecting the particular skill for training because its performance will enhance the physical well being of the client.

8. Social Contact Enhancement:

Social Contact Enhancement refers to the need to select a particular skill for training because it is likely to increase the number of interactions with non-disabled people.

9. Acquisition Probability:

We should not select skills to teach that are highly unlikely to be learned. We should only teach skills that have a very good chance of being acquired by the person receiving our services.

10. Status Enhancement:

We should teach skills that are likely to enhance the social status of the client.

2. Developing training plans for the clients

By observation and interviews with the person being served and their "significant others", members of what is often referred to as the Interdisciplinary Team will determine what needs to prioritize for training. You will likely be a part of this process. In most formal programs this information becomes the Individualized Service Plan, (or ISP). This plan will provide background information and the reasons for deciding what goals and objectives need to be taught during the year.

The ISP will provide direct-care and training staff with specific information as to how any training will be carried out. You will be responsible for reading and understanding the ISP of everyone you provide services for in your program. Also, it is important to know that during the year changes can be made in these plans. Your supervising staff will be responsible for informing all involved staff of these changes whenever they occur.

3. Implementing the training plans

As the ISP is developed, schedules are also developed to insure that training occurs at the best times. Documentation forms and other paperwork associated with the training should also be made available to all involved staff before the training begins. Finally, your supervisor should review the ISP and allow you to ask questions before you begin the training process with your client(s).

Following the schedules, using the appropriate materials, following training instructions, and providing the necessary documentation, is the backbone of the Active Treatment Process.

4. Assessing the effectiveness of the training

As you provide training, it is important for you to understand that documentation is the primary means of determining the effectiveness of your efforts. Poor or missing documentation will directly result in confusion in planning as time goes on. Written comments must be clear and coded responses on data collection forms must reflect the actual response of your client during training. If little or no progress is being made toward the learning of a new skill, this should be reported to a supervisor. Changes can be made in the training instructions that can improve the chances of success.

Questions for Discussion

1. Why do you think it is so important to involve those we provide care for in learning new skills continuously?

2. How do we know what to focus on in the training process? How do we learn how to go about providing the right training?

3. If one of your client's goals addresses the need to increase recreational skills, where would you provide training? Why?