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Living the Good Life: Adult Community Living in the Family Teaching Model. Diane Bannerman Juracek, Ph.D., BCBA Community Living Opportunities, Inc. - PowerPoint PPT Presentation
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Living the Good Life: Living the Good Life: Adult Community Living in Adult Community Living in the Family Teaching Modelthe Family Teaching Model
Diane Bannerman Juracek, Ph.D., BCBADiane Bannerman Juracek, Ph.D., BCBA
Community Living Opportunities, Inc.Community Living Opportunities, Inc.
CLO’s mission is to help adults and children with severe CLO’s mission is to help adults and children with severe developmental disabilities achieve personally satisfying developmental disabilities achieve personally satisfying
and fulfilling lifestyles in their own communities.and fulfilling lifestyles in their own communities.
CLO’s ServicesCLO’s Services Residential Options Residential Options Day Classes Day Classes Supported EmploymentSupported Employment Health Care Services: Clinics in Lenexa and Health Care Services: Clinics in Lenexa and
LawrenceLawrence Applied Behavior Analysis ConsultationApplied Behavior Analysis Consultation Positive Behavior SupportsPositive Behavior Supports Children’s Services Children’s Services Training, Evaluation and CertificationTraining, Evaluation and Certification Outreach ServicesOutreach Services Remote MonitoringRemote Monitoring Midnight FarmMidnight Farm
Midnight FarmMidnight Farm 6 miles south of Eudora 6 miles south of Eudora
2 Extended Family Teaching Homes (Each 2 Extended Family Teaching Homes (Each housing a family and 1 or 2 people with housing a family and 1 or 2 people with developmental disabilities)developmental disabilities)
Multipurpose facility: with meeting lodge, Multipurpose facility: with meeting lodge, bunkhouse, equestrian facility/arena, barn, bunkhouse, equestrian facility/arena, barn, staff for horses and other animals staff for horses and other animals
Summer Day Camps for children with Summer Day Camps for children with autism: 6-18autism: 6-18
Equestrian programEquestrian program
In 2008, CLO serves approximately In 2008, CLO serves approximately 465 adults & children465 adults & children
269 Adults with developmental disabilities (DD) 269 Adults with developmental disabilities (DD) 196 Adults with DD in residential services 196 Adults with DD in residential services 73 Adults with DD in only day services and/or 73 Adults with DD in only day services and/or
Targeted Case Management Targeted Case Management
105 children with autism or other developmental 105 children with autism or other developmental disabilities in Children’s Servicesdisabilities in Children’s Services
82 children served in our Montessori Preschool82 children served in our Montessori Preschool 9 at-risk families in Family and Youth 9 at-risk families in Family and Youth
Intervention program Intervention program
Building the “Good Life”Building the “Good Life”
Residential Service Models Residential Service Models at Community Living at Community Living Opportunities, Inc.Opportunities, Inc.
8 housemates 8 housemates Awake shift staff 24 hours a dayAwake shift staff 24 hours a day Funded by Medicaid as a Private Intermediate Care
Facilities for Adults with Mental Retardation (ICF/MR)
3 housemates3 housemates Living in an apartment or homeLiving in an apartment or home Awake shift staff 24 hours a dayAwake shift staff 24 hours a day Funded by Medicaid Home & Community Based Services
(HCBS) waivers for persons diagnosed with Developmental disabilities
Group Home
Individualized
Living
This just isn’t working!
Residential Service Models Residential Service Models at Community Living at Community Living Opportunities, Inc.Opportunities, Inc.
3 or 4 housemates 3 or 4 housemates A family teaching couple provides A family teaching couple provides most of the support, lives next most of the support, lives next door and manages the homedoor and manages the home
Lives with a teacher without Lives with a teacher without disabilities or a teaching family in disabilities or a teaching family in the same homethe same home
Both programs funded through Medicaid’s Home and Both programs funded through Medicaid’s Home and Community-based Waiver for people with DDCommunity-based Waiver for people with DD
Family Teaching
Extended Family
Teaching
Number of People Across CLO Residential Number of People Across CLO Residential ModelsModels 2008 2008
50
11
97
38
Shift-supported homes Apartments Family Teaching Model Extended Family Teaching Model
Family Teaching Model* Family Teaching Model* ComponentsComponents
*An adaptation of the Teaching Family Model *An adaptation of the Teaching Family Model (Phillips, Phillips, Fixsen, & Wolf, 1974)(Phillips, Phillips, Fixsen, & Wolf, 1974)
Family Teachers in family style living Family Teachers in family style living environmentsenvironments
Individualized daily schedulesIndividualized daily schedules Teaching new skillsTeaching new skills Systems for encouraging achievementSystems for encouraging achievement Positive relationshipsPositive relationships Opportunities for choice and self determinationOpportunities for choice and self determination Ongoing teacher training and consultationOngoing teacher training and consultation Teacher evaluation and certificationTeacher evaluation and certification
Library
Tom's Choice
Work @ Recycling Center
Library
Ed's Choice
Swimming Swimming Swimming
Work @ Recycling Center
ThurThurss SamSam Ken Ken TimTim
7:00 7:00 AMAM
AM Routine*AM Routine* AM Routine *(bath routine)AM Routine *(bath routine)Sally Sally (Family Teacher)(Family Teacher) goes goes
joggingjoggingAM Routine*AM Routine*7:30 7:30
AMAM
8:00 8:00 AMAM MedsMeds MedsMeds MedsMeds
8:30 8:30 AMAM Wait for City BusWait for City Bus R & R R & R R & R R & R
9:00 9:00 AMAM
10:00 10:00 AMAM
11:00 11:00 AMAM
12:00 12:00 PMPM Lunch (*Lunch routine)Lunch (*Lunch routine) LunchLunch
1:00 1:00 PMPM
2:00 2:00 PMPM
3:00 3:00 PMPM
4:00 4:00 PMPM
4:30 4:30 PMPM MedsMeds Meds/ Dinner Prep Routine*Meds/ Dinner Prep Routine* MedsMeds
5:00 5:00 PMPM Dinner/ ChoresDinner/ Chores Dinner/ ChoresDinner/ Chores Dinner/ ChoresDinner/ Chores
5:30 5:30 PMPM
6:00 6:00 PMPM
6:30 6:30 PMPM
7:00 7:00 PMPM
Sally (family teacher) takes Sally (family teacher) takes Katie (daughter) to Girl Katie (daughter) to Girl
Scouts Scouts Hobby ChoiceHobby Choice Check mail and choice of ActivityCheck mail and choice of Activity
7:30 7:30 PMPM SnackSnack Snack Routine*Snack Routine* SnackSnack
8:00 8:00 PMPM Meds/ PM Routine*Meds/ PM Routine* Meds/ PM Routine*Meds/ PM Routine* Meds/ PM Routine*Meds/ PM Routine*
to recycling centerto recycling center
Walk High School Track*Walk High School Track* Walk at High School Track Walk at High School Track While John (family teacher) goes to gym
LibraryLibraryKevin’s choice
Reinforcing Desirable Behavior*
1. Initiate Positivelya. Use Active Listening Skills (e.g., eye contact, responsive facial expression & voice tone, active listening posture, gestures, verbal and non-verbal encouragement, and reflection)b. Expression of Affection(e.g., smile, greeting, joke, physical contact)
2. Praise and Positive Consequence (descriptive, immediate)
*Some steps may be deleted or shortened depending on the needs and learning style of the individual.
Teaching a New Skill* 1. Initiate positivelya. Use active listening skills (eye contact, responsive facial expression and voice tone, body posture, and gestures).b. Elicit person’s involvement throughout the interactionc. Expression of affection (e.g., smile, greeting, joke, physical contact)
2. Name appropriate behavior
3. Rationale (e.g., positive consequence of engaging in the appropriate behavior) Ask or give
4. Demonstrate the steps
5. Practice (Use prompts with fading, if necessary)
6. Feedback a. Reinforce: descriptive praise, optional positive consequence b. corrective feedback if needed
7. Practice
8. Feedback a. descriptive praise, optional positive consequence b. corrective feedback if needed
9. Plan when to use the behavior *Some steps may be deleted or shortened depending on the needs and learning style of the individual .
The Community Living Research and Development Project
at theUniversity of Kansas
Family Teacher Certification Program
Providing Certification of
Family Teachers employed byCommunity Living Opportunities, Inc.who exhibit exemplary teaching and
implement Community Living Opportunities' Family Teaching Model for Adults with
Developmental Disabilities
Community Living Opportunities Community Living Opportunities
Expected OutcomesExpected Outcomes for Persons Served for Persons Served
Pleasant and Safe SurroundingsPleasant and Safe SurroundingsObservance of Legal and Personal RightsObservance of Legal and Personal Rights
Positive Relationships with OthersPositive Relationships with OthersLiving Healthy LifestylesLiving Healthy Lifestyles
Opportunities for Choice and ControlOpportunities for Choice and ControlEffective Learning Opportunities Effective Learning Opportunities
High Level of Participation in Daily High Level of Participation in Daily ExperiencesExperiences
Community InvolvementCommunity InvolvementEffective CommunicationEffective Communication
Pleasant Social EnvironmentPleasant Social EnvironmentSatisfied ConsumersSatisfied Consumers
Family Teaching Model Certification• FTM Pre-service Workshop • Shadow Training• Program Specific Orientation• 12 Coaching Lessons • 90 Day Evaluation• More Coaching Lessons based on Outcome
QEs• Family Teaching Model Workshop• Pre-evaluation meeting for First Private• 6 mos. after hire: First Private
Evaluation • Quality at a Glance Evals • Pre-evaluation meeting for Certification
Evaluation • 12 mos. After hire: Certification
Evaluation
Certification Celebration and $$
Benefits of the Family Teaching Model &Extended Family Teaching
Model
Community Living Opportunities Community Living Opportunities
Expected OutcomesExpected Outcomes for Persons Served for Persons Served
Pleasant and Safe SurroundingsPleasant and Safe SurroundingsObservance of Legal and Personal RightsObservance of Legal and Personal Rights
Positive Relationships with OthersPositive Relationships with OthersLiving Healthy LifestylesLiving Healthy Lifestyles
Opportunities for Choice and ControlOpportunities for Choice and ControlEffective Learning Opportunities Effective Learning Opportunities
High Level of Participation in Daily High Level of Participation in Daily ExperiencesExperiences
Community InvolvementCommunity InvolvementEffective CommunicationEffective Communication
Pleasant Social EnvironmentPleasant Social EnvironmentSatisfied ConsumersSatisfied Consumers
Atc
hiso
n
Elm
woo
d
Con
ser
Pon
dero
sa
Mar
ty/L
ane
ILP
1 D
C
ILP
2 D
C
ILP
3 D
C
FTM
11
FTM
5
Ben
son
FTM
FTM
2
FTM
9
FTM
1
PA
/ D
H
BW
/ M
Y /
DT
MG
/ S
O /
DT
DU
JD SS
LS /
DB
TT TF
N/A
2005
CLO Outcomes
Effective CommunicationPleasant & Social Environment
Group Homes ILP Family Teaching Homes Extended Family
Met During Comprehensive Annual Evaluation
Consumer SatisfactionGreetings & Tours
RightsPleasant & Safe Surrounding
EngagementCommunity Involvement
Effective Learning OpportunitiesChoice & Control
Living Healthy LifestylesPositive Relationships
Group Home FTM M
EFT
ILP
Pleasant & Social EnvironmentEffective CommunicationCommunity Involvement
EngagementEffective Learning Opportunities
Met During Comprehensive Annual EvaluationCLO Outcomes
Choice & ControlLiving Healthy Lifestyles
Positive RelationshipsRights
Pleasant & Safe Surrounding
FAM
ILY
TEA
CH
ING
MO
DEL
SHIF
T ST
AFF
Significant Improvement Needed: less than 40% of homes met some of the expectations
2008 EXTE
ND
ED F
AM
ILY
TEA
CH
ING
MO
DEL
Exceeds Professional Expectations 100%: of homes evaluated met all of the expectations
Improvement Needed: 40-50% of homes met some of the expecations
Minor Improvement Needed: 60-79% of homes evaluated met some of the expectations
Meets Professional Expectations: 80-99% of homes evaluated met some of the expectations
11
4.9
3.22.8 2.8
0
2
4
6
8
10
12
Year 1984 Year 2002 Year 2004 Year 2007 Year 2008
CLO Average Number of People Per HomeAcross years
Nu
mb
er
Percent Staff Turnover Across Direct Support Positions
CLO - 2008
6660
4744
13
0
10
20
30
40
50
60
70
80
90
100
Shift-supportedHome Staff
Apartment Prog.Staff (SEK)
Night Staff Family TeachingModel Staff
Extended FamilyTeaching Model
Staff
Pe
rce
nt
Average Parent Guardian Satisfaction Average Parent Guardian Satisfaction with CLO Community Living Modelswith CLO Community Living Models
4.74.9
5.4 5.5
1
2
3
4
5
6
Shift-supported Homes Apartments Family Teaching Model Extended Family TeachingModel
April and October 2008 Sent 464 Received 176 (38%) Number of Persons Served
196 Rating Scale 6=Very Satisfied 5=Satisfied 4=Slightly Satisfied
3=Slightly Dissatisfied 2=Dissatisfied 1=Very Dissatisfied
Average Teacher SatisfactionAverage Teacher Satisfaction CLO - 2008CLO - 2008
4.9
4.1
4.9
1
2
3
4
5
6
Shift Staff Satisfaction Family Teacher Satisfaction Extended Family Teacher Satisfaction
Rating Scale 6=Very Satisfied 5=Satisfied 4=Slightly Satisfied 3=Slightly Dissatisfied 2=Dissatisfied 1=Very Dissatisfied
Average Number of Persons-served per Teacher Across Residential Models
CLO - 2008
2.2
3
2.5
1
0
0.5
1
1.5
2
2.5
3
3.5
Shift-Supported Homes Apartments Family Teaching Model Extended FamilyTeaching Model
Nu
mb
er
11
4.9
3.2 2.8
0
2
4
6
8
10
12
Year 1984 Year 2002 Year 2004 Year 2007
Average Number of People Per HomeAcross years
Nu
mb
er
Living the Good Life:Living the Good Life:A Retrospective Analysis of A Retrospective Analysis of
challenging Behaviors and Health challenging Behaviors and Health Indicators for Individuals Across Indicators for Individuals Across
Residential ModelsResidential Models
James Sherman and Jan Sheldon James Sherman and Jan Sheldon (University of Kansas)(University of Kansas)
Michael Strouse, JAMIE PRICE, DIANE BANNERMAN Michael Strouse, JAMIE PRICE, DIANE BANNERMAN JURACEK, and HOLLY M. SWEENEY (Community Living JURACEK, and HOLLY M. SWEENEY (Community Living
Opportunities, Inc.)Opportunities, Inc.)
Case Study – Brad Case Study – Brad
DescriptionDescriptionBrad is a 43 year old man with Autism and visual Brad is a 43 year old man with Autism and visual
impairments.impairments.He loves going to musicals, playing Uno, He loves going to musicals, playing Uno,
spending holidays and special occasions with spending holidays and special occasions with his family. He is described as being a good his family. He is described as being a good friend and brother, routine oriented, having a friend and brother, routine oriented, having a good sense of humor and an excellent memory.good sense of humor and an excellent memory.
Residential Living HistoryResidential Living History1991 – Group Home1991 – Group Home1996 – Family Teaching Home1996 – Family Teaching Home2003 – Extended Family Teaching Home with a 2003 – Extended Family Teaching Home with a
family. family.
0
5
10
15
20
25
30
35
1992 1993 1994 1995 1996 1997-GH
1997-FTM
1998 1999 2000 2001 2002 2003-FTM
2003-EFT
2004 2005
Avera
ge insta
nces P
er
Month
Brad Brad Screaming and Biting Others Screaming and Biting Others
Group Home Extended FamilyFamily Teaching
Case Study – Troy Case Study – Troy
DescriptionDescription
Troy is a 23 year old male with Autism.Troy is a 23 year old male with Autism.
He is described as being very affectionate, He is described as being very affectionate, honest, having a good work ethic, a quick honest, having a good work ethic, a quick learner and having a great sense of humor. learner and having a great sense of humor.
Residential Living HistoryResidential Living History
2001 – Family Teaching Home 2001 – Family Teaching Home
2003 – Extended Family Teaching Home with a 2003 – Extended Family Teaching Home with a family. family.
35.8
30.1
14.28
8
4.51.8
0
5
10
15
20
25
30
35
40
2001-FTM 2002-FTM 2003-FTM 2003-EFT 2004-EFT 2005-EFT
Avera
ge P
er
Month
TroyTroy Crying, Swearing, Yelling and Physical AggressionCrying, Swearing, Yelling and Physical Aggression
Extended FamilyFamily Teaching
0.33 0.17 0.08 0 0.42 0
25
14
0.570
5
10
15
20
25
30
July28-Aug97
Sept97-
Sept99
1999 2000 2001 2002 2003 2004 2005
Avera
ge I
nsta
nces P
er
Month
BobBobPhysical AggressionPhysical Aggression
Family Teaching
FTM ILP EFT
2.3 1 0 0 1 0.3
37
26
0.750
5
10
15
20
25
30
35
40
July28-Aug
97
Sept97-
Sept99
1999 2000 2001 2002 2003 2004 2005
Avera
ge N
um
ber
of
Fifte
en M
inute
Inte
rvals
BobBobVerbal AggressionVerbal Aggression
Family Teaching
FTM ILP EFT
20 20 20
0 0 0 0 0
20
1 1 0.250.250.250.25 0.251
1
0
5
10
15
20
25
1997-FTM/ILP
1998-ILP 1999-EFT 2000-EFT 2001-EFT 2002-EFT 2003-EFT 2004-EFT 2005-EFT
Mill
igra
ms
Desipramine Risperdal
BobBobPsychotropic MedicationPsychotropic Medication
1.75
0.9
0.831.6
0.56
1.1
0.67
1.5
10.1
0
1
2
3
4
5
6
7
8
9
10
11
1997-FTM/ILP
1998-ILP 1999-EFT 2000-EFT 2001-EFT 2002-EFT 2003-EFT 2004-EFT 2005-EFT
Ave
rage
Num
ber
Per
Mon
th
Anticonvulsant Medications Seizures
BobBobSeizures and Anticonvulsant MedicationSeizures and Anticonvulsant Medication
Factors Influencing Factors Influencing “Living the Good Life”“Living the Good Life”
Fewer number of individuals living in a homeFewer number of individuals living in a home Durable Dance Partners Durable Dance Partners (shift staffing vs. families providing care) (shift staffing vs. families providing care) Implementation of Family Teaching Model ComponentsImplementation of Family Teaching Model Components
Family Teachers in family style living environmentsFamily Teachers in family style living environments Individualized daily schedulesIndividualized daily schedules Teaching new skillsTeaching new skills Systems for encouraging achievementSystems for encouraging achievement Positive relationshipsPositive relationships Opportunities for choice and self determinationOpportunities for choice and self determination Ongoing teacher training and consultationOngoing teacher training and consultation Teacher evaluation and certificationTeacher evaluation and certification
Thank you for your time and interest.
Please feel free to contact me for further information:
Diane Bannerman Juracek, Ph.D. dianebannermanjuracek@clokansas.org
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