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