The Imperial County Program for Children with Autism

An Intervention Program for Children with Autism and a Parent Support Group in Imperial County

Stanley L. Swartz, Ph.D.

 

 

 

Program Design

 

A.       Program Description

 

The Imperial County Program for Children with Autism is an after school program and parent support group that will provide services to children with autism and their families. These services include direct work with children to increase socialization, communication, and appropriate behaviors, training activities for parents and siblings, and a support group for parents.

The program uses a model that recognizes the complexity of providing appropriate programs for children with autism and the need for collaboration with all service providers. The program is designed to provide an individually developed behavioral/socialization program for children with autism to support their maximum inclusion in school and community activities. The program is supplemental in nature and coordinated with any other programs currently in place.

 

B.  Entrance and Exit Criteria – i.e., age of consumer, behavioral criteria, attendance policy

 

Children served in this program are consumers referred by the San Diego Regional Center. The program serves children diagnosed with autism and who have difficulty with social interaction and play, self-help skill deficits, and behavior excesses.  Children ages 3 years – 22 years are eligible for participation in the program.

 

A second program entrance criterion is parents willing to attend the Parent Support Group and cooperate with program staff by implementing program recommendations.

 

Regular attendance is required for continuation in the program

 

 

C.        Length of Service

 

Service duration varies according to consumer with needs with program exit decisions made as a consultation between program staff, parents, and Regional Center staff.

 

D.  Location where service is to be provided

 

The After School Program is conducted both in the home and in various community settings.  The Parent Support Group meets in various community rooms in El Centro.

 

 

E.  Hours the Program is in operation

 

The After School Program begins at approximately 3:30.  The Parent Support Group for parents of children in the After School Program begins at 5:00pm and ends at 7:00.  The Parent Support Groups will operate on Monday afternoons, except for holidays.

 

 

F.         Grievance Procedure to address consumer and family concerns

 

Parents have two levels to express their concerns about the program.  The first level is a direct appeal to the program director.  Failure to resolve the concern at this level will give parents the opportunity to express their concerns to a group composed of a Regional Center representative, a representative of the Parent Support Group, and one member of the program staff other than the director.  The recommendations of this group will be advisory to the program director.

 

 

G.       Curriculum/assessment – Describe curriculum of program and submit a copy for an example assessment

 

Curriculum/Services

The Imperial County Program for Children with Autism includes various programmatic elements to ensure a high level of parent support, collaboration with teachers and other professionals, and a seamless program design that is carefully coordinated.

These include:

1.      After School Program

The Level 1 is an in-home and community-based program.  The program consists of one-to-one intervention to improve behavior, socialization, and communication skills of participants. Parents receive instruction on the use of the strategies employed in this program.  Each child has an individual therapist whose work is directly supervised by an Associate Director.

Parents are supported with in-home consultation based on individual needs.  Programs are developed for in-home use on problems directly related to successful participation in the program.  Techniques are modeled by program personnel and parents are directly trained in the use of effective strategies. This program element is directed at parents (or caregivers), siblings, and other family members.  Information collected during in-home visits, particularly videotaped behavior patterns, can be used to modify programs and monitor program success.

The Level 2 program is a center-based program.   The program provides a small group (up to 3) intervention with a two or three-to-one student, staff ratio to children who make good progress in the one-to-one program.  Children in Level 2 are trained in the higher level socialization and communication skills considered to be prerequisite to successful participation in small group instruction.  The Level 2 activities are considered a necessary preparation for transition to more inclusive settings.

Sample Schedule

3:30-3:45            Arrival and transition activity

3:45-4:15            Level I – individual focus on communication

                        Level II – socialization group

4:15-4:45            Level I – individual focus on self-help skills

                        Level II – group focus on recreation activity

4:45-5:15            Level I – individual focus on presenting or target behaviors

                        Level II – communication activity

5:15-5:45            Level I – individual focus on social interaction and play

                        Level II – socialization group 

5:45-6:15            Level I – continued focus on social interaction

                        Level II – continued socialization group

6:15-6:30            Parent consultation with therapy staff and transition

 

2.  Parent Support Group

Parent support and training are an integral part of the program for each child.  Participation in the support group is required for participation in the program to promote effective coordination of strategies used at home with those employed in the program.  Emphasis is on helping parents develop more effective methods of behavior modification and in establishing a workable daily routine for the participation of the child in the home.  The support group focuses on various personal and family issues associated with raising a child with autism.  This support group meets weekly and is facilitated by an Associate Director or other trained counselor.  The supprt group is conducted in both English and Spanish.

Sample Schedule

5:30-7:30         Parent support group

                         Individual consultation with parents including observation of children

 

Assessment

All referrals to the program receive a twelve-hour intake assessment.  This includes an in-home parent interview, videotaping of behavior samples, a school visit, and a functional analysis of disruptive and inappropriate presenting behaviors. The results of the functional assessment of behavior, reports from school and Regional Center, and parent treatment priorities are used to develop the individual program and to identify the initial target behaviors.

A baseline of behaviors exhibited in the After School Program are developed during the first month, approximately 12 hours over 4 sessions.  A preliminary goal of 5% increase in appropriate behaviors and an accompanying 5% reduction in inappropriate behaviors will be established.  This progress will be reviewed quarterly with reports documenting progress in meeting goals submitted on a semiannual basis to determine program progress continuation.

Parent Support Group participation is evaluated by parent report and the clinical impressions developed by the counselor.  Continuation is by mutual agreement regarding both the progress of their child and the usefulness of the support group.

 

 

 

H.  Staff Qualifications

Dr. Stanley L. Swartz is the Director of the program and designs each individual program, consults with parents, and supervises the training of all staff.

Dr. Swartz has degrees in psychology and education and is Professor of Special Education at California State University, San Bernardino.  He is also a visiting faculty member at the Universidad Nacional Autonoma de Mexico, University of California, Riverside, Universidad Autonoma de Baja California, and Universidad La Habana.  He has thirty years of experience working with children with disabilities and has designed and managed a wide variety of programs for children with special needs. Dr. Swartz has contributed to fifteen books and more than 100 articles and research papers.  Dr. Swartz is a Fellow of the American Orthopsychiatric Association and the American Association on Mental Retardation and a member of the American Psychological Association

Janet Maule Swartz is the Program Administrator and provides general administrative oversight for the project and hires, supervises, and evaluates all employees.

Ms. Swartz has degrees in education and counseling and is a Special Education Administrator for the Colton Joint Unified School District.  She holds the California Pupil Personnel Services Credential endorsed as a social worker and counselor.

Lilia Lopez serves as an Associate Director with primary responsibility for the Parent Support Group.  Ms. Lopez is a psychologist and holds the master’s degree in special education from California State University, San Bernardino and is faculty member at the Universidad Autonoma de Baja California.  She is also an associate director of the Instituto de Atencion Psicologica y Asesoria para la Discapacidades del Desarrollo, A.C.  She served an internship in autism at the University Center for Developmental Disabilities at California State University, San Bernardino under the supervision of Dr. Swartz.

Esther Vazquez serves as an Associate Director with primary responsibility for the After School Program.  Ms.Vazquez is a psychologist and holds the master’s degree in special education from California State University, San Bernardino and is faculty member at the Universidad Autonoma de Baja California. She is the director of the Centro de Atencian al Nino Autista de Mexicali, Instituto del Nino Autista and an associate director of the Instituto de Atencion Psicologica y Asesoria para la Discapacidades del Desarrollo, A.C.  She served an internship in autism at the University Center for Developmental Disabilities at California State University, San Bernardino under the supervision of Dr. Swartz. 

Therapists

One-to-one therapists are recruited from the community, both Imperial County and Mexicali.  All personnel employed by the program are specially trained for work with children with developmental disabilities and their families. Training is research-based and represents best practices in behavior modification and strategies to increase socialization and communication.  All personnel are trained in positive behavior intervention and expected to use these techniques in all of their interaction with children.  Initial training is 15 hours and ongoing training of 2 hours per month is required.  All therapists are employed as hourly employees and performance is reviewed every 30 days.  All therapists in the After School Program are under the direct supervision of an Associate Director.

 

H.  Personnel Organization Chart to include all staffing positions

 

A Program Advisory Committee provides support for program development and operation and will be composed of representatives from the program staff, parents, Regional Center, school, and community.

 

Organizational Chart

 

Program Advisory --Program Administrator------Program Director------Regional Center

          Committee                                                                                            Staff

/

/

/

Associate Director----------------Associate Director

                              After School Program                   Parent Support Group

                                                /                                                 

                                    Therapists                                              

                                                           

 

 

 

 

I.           Staff-to-consumer ratio

 

The After School Program has two levels.  In Level I the staff-to-consumer ratio will be one-to-one, one therapist/one child, plus supervisory personnel.  In Level II, the ratio is two or three to one for the small group work.

 

The Parent Support Group has a staff-to-consumer ratio of eight family units to one counselor.

 

 

J.         Program Capacity

 

The client capacity is 8-10 children in the After School Program and up to 20 parents in the Parent Support Group.

 

 

K.       Program Goals/Intervention Philosophy

 

One of the major obstacles to the inclusion of children with disabilities in both school and the community, is behavior that is inappropriate and disruptive.  For children with severe disabilities, behaviors such as tantrums, aggression, or self-injury are challenging beyond what regular education settings are prepared to handle.  Families of children with severe disabilities are also looking for assistance beyond the traditional manipulation of consequences offered by most behavior management programs. 

 

If we are to accomplish inclusion, it will be necessary not only to identify treatment methods that work, but ones that will be acceptable in the context of inclusive environments.  The three concepts of social validity identified by Wolf (1978) are important considerations in reaching this goal.  These are feasibility - are we able to use the strategy;  desirability – are we willing to use the strategy; and effectiveness – does the strategy make a difference for the individual in increasing inclusion opportunities? In other words, we need treatment strategies that both parents and teachers are able and willing to use and that make a real difference for the individual and their opportunities to participate in school and in the community. 

                       

An increasing body of research in the use of positive behavior support (PBS) has demonstrated that these strategies are highly effective for use with the behaviors presented by children with severe disabilities (Carr, Horner & Turnbull, 1999).  In addition, PBS meets the various social validity criteria in most cases and facilitates inclusion of children with disabilities. Unlike traditional behavior management, which views the individual as the sole problem and seeks to “fix” him or her by quickly eliminating the challenging behavior, PBS views such things as settings and lack of skill as parts of the “problem” and works to change those.  As such, PBS is characterized as a long-term approach to reducing the inappropriate behavior by teaching a more appropriate behavior, and providing the contextual supports necessary for successful outcomes (ERIC, 1999).

 

Effective behavior change must not only reduce inappropriate behaviors it must also teach suitable alternatives.  These changes should not only help the child in the immediate environment, or the short term, they must also be important for their life after school, or the long term.  The key concept of PBS was then determined to be to change a problem behavior, it is first necessary to remediate deficient contexts.  Deficient contexts were found to come in two varieties, those related to behavior repertoires and those related to environmental conditions.   Behavior repertoires means that the individual does not have the necessary behaviors to be successive.  Communication skills, social skills, self-management are all found to be inadequate for the demands of their day-to-day existence, whether school, home, or community.  Environmental conditions means that the stimuli in any particular environment are not conducive to appropriate behavior for this individual and contributes to the emergence of problem behaviors. 

 

In applying PBS, the research review completed by Carr and his colleagues found two categories of intervention: stimulus-based and reinforcement-based (Carr, et al., 1999).  When environments are deficient it is when there are too few stimuli to support positive behavior and that changes in this environment are necessary as part of the effort to help children with disabilities exhibit more appropriate behavior.  On the other hand, from a reinforcement perspective, the existence of positive behaviors competes with or makes negative behaviors unnecessary because the positive behaviors provide an alternative for accessing the available reinforcement.  In sum, PBS tries to change the environment so that the conditions for appropriate behavior and its reinforcement are available and to teach appropriate behaviors as a substitute for accessing reinforcement in the environment.

 

Positive behavior support appears to be best suited for long-term change and is proactive to the extent that it attempts to teach behaviors and impact the environment that surrounds these behaviors.  This is contrasted to aversive or punitive approaches that seem best suited to a crisis management mode.  From the perspective of the family, and in keeping with the principles of social validity, PBS would seem to be the appropriate choice because of its good fit with a family environment.   Parents are able to work with their children using techniques that are effective and at the same time part of a normal pattern of interaction.   From the perspective of the school, PBS is a good match because of its suitability for use in inclusive settings and because it is primarily a teaching method.   Positive behavior support is procedure more likely to encourage the inclusion of children with disabilities in regular classrooms.

 

Redirective Therapy

 

            Redirective Therapy is a method of Positive Behavior Support and was developed as part of a training program in a university clinic for parents and families of children with pervasive developmental disabilities (Swartz,  1994).  Parents had reported that though some techniques currently available appeared to be effective, they were too harsh and too unusual as a pattern of parent-child interaction.  They felt that the treatment became an aversive to both parent and child because of its intensity and that its suitability for the community or an inclusive school setting was an issue.  The criteria used in the development of Redirective Therapy (RT) was that it must allow for a positive interaction between parents and their children and that it must be suitable for use in all settings.  Using research in nonpunitive techniques (Donnellan, et al., 1998) the strategy focused on a simple pattern of redirection with teaching an appropriate behavior as the end goal.  Similar in this regard to the strategy identified as differential reinforcement of alternative behavior (DRA), Redirective Therapy diverged by electing to use only social rewards.  It was felt that since one of the primary goals for most children in the program was increased socialization, the use of social rewards would be the first important step in teaching social skills. 

 

Therapists using RT were taught to interrupt the undesired behavior and redirect the child to an appropriate behavior.  They were instructed to do this interruption in the least intrusive way possible (for example, a word or a gesture would be a preferable interruption to a physical cue).  Social reinforcement (praise or touch, or both) would immediate follow the interruption and redirection.  In this way, the concern about limited availability of reinforcement in the use of differential reinforcement of other behaviors (DRO) could be resolved.  This pattern was repeated until the child stayed on the new task and exhibited an appropriate behavior.  Parents reported that their good feeling about this strategy was that they could use it at home and on any trips into the community.  In another words, it met both the social validity criteria of feasible (I can use it) and desirable (I will use it). 

 

Redirective Therapy will be the treatment used in the After School Program and encouraged in the Parent Support Group and In-Home Program.  Emphasis in the After School Program will be on teaching behaviors and in the Parent Support Group and In-Home Program on both teaching behaviors and changes in the environment.

 

 

 

References

Carr, E.G., Horner, R.H., & Turnbull, A.P. (1999).  Positive behavior support for people with developmental disabilities.  Washington, DC: American Association on Mental Retardation.

 

Donnellan, A., LaVigna, G., Negri-Shoultz, N., & Fassbender, L. (1988).  Progress without punishment. New York: Teacher’s College Press.

 

ERIC Research connections in special education (Winter, 1999). Positive behavior support.  ERIC Clearinghouse on Disabilities and Gifted Education.

 

Swartz, S.L. (1994). Redirective therapy: Guidelines for use in school and home.

San Bernardino, CA: California State University.

 

Wolf, M.M. (1978).  Social validity:  The case for subjective measurement, or how applied behavior analysis is finding its heart.  Journal of Applied Behavior Analysis, 11, 203-214.