Promoting Intensive Socialization of Mildly Retarded Within an Institution

DOCUMENT RESUME

ED 054 568 EC 033 217 AUTHOR Graebner, Oliver E.; And Others TITLE Promoting Intensive Socialization ofMildly Retarded Within an Institution. INSTITUTION Austin State School, Tex. SPONS AGENCY National Inst. of Ment:11 Health (DHEW),Bethesda, Md. PUB DATE 70 NOTE 83p. EDRS PRICE MF-$0.65 HC-$3.29 DESCRIPTORS Behavior Change; *Educable MentallyHandicapped; *Institutjonalized (Persons ) ; Mentally Handicapped; Research Projects; *Residential Programs:Social Development; *Socialization

ABSTRACT Eight papers report on the project atAustin State School, funded by a Hospital Improvement(HIP) grant, which used a multidisciplinary team to implementsocialization programs for institutionalized mildly retarded personsexhibiting socially inept behavior. Two papers considersocial rehabilitation and the task of trying to move residents out intocommunity lite. The third paper tells how dormitory attendants can serveas teachers rather thanjust keepers. The fourth and fifth papersreport on a training and education program for a group ofemotionally disturbed girls, applying a behavior modificationmodel. A half-way house programfor stable working older women residents onthe State School grounds is described in the sixth paper. Thelast two papers deal with outreach services to bring former residentsand families back together again as part of atherapeutic and rehabilitative program,and with social work graduate training within theHIP project respectively.. A threefold increase in rate of discharges(residents able to successfully make their way inregular society) over a previous similar period of time is cited asevidence of HIP p oject success. (Author/KW) PROMOTiNG INTENSIVE SOCIALIZATION OF MILDLY

LA, RETARDED WITHIN ANINSTITUTION

A Collection of Papers Developed and Written by Members of the HIP Staff at Austin StateSchool, Austin, Texas

June 1965 to May 1970

U.S. DEPARTMENT OF HEALTH, EDUCATION WEL!-ARE OFFICE rF EDUCATION THIS DOCUMENT HAS SEEN REPRODUCED EXACTLY AS RECAVED FROM THE PERSON OR ORGANILATION ORIGINATING IT. POINTS OF ViEw OR OPINIONS STATED DO NOT NECES- SARILY REPRESENT OFFICIAL OFFICE OF mu- CATION POSITION OR POLICY

This project was supported in toto byHospital Improvement Grant MH R20 MHO 2167;

National Institute of MentalHealth Bethesda, Maryland CONTENTS

FOREWORD By Oliver k. Graebner, Ed. D. iv

PART HOW CAN WE HELP 40,000 MENTALLY RETARDED GET DISCHARGED FROM INSTITUTIONS? Oliver E. Graebner, Ed. D.

PART II A NETWORK OF RESIDENTIAL PROGRAMMING TOFACILITATE SOCIAL REHABILITATION Ralph M. Scheer, ACSW 12

PART III TRAINING ATTENDANIS TO BE DORMITORY TEACHERS OF THE MENTALLY RETARDED

Sharryl Hawke, M. A.

PART iV PROGRAMMING FOR EMOTIONALLY DISTURBED, RETARDED CHILDREN IN A BEHAVIOR MODIFICATION SETTING Sharryl Hawke, M. A. 25

PART V THE TREATMENT UNIT: A TOTAL TOKEN ECONOMY FOR DISTURBED RETARDATES Robert Conrad, M. A.

PART VI PC/CT WI( VILLAGE = CAMPUS HALF-WAY HOUSES Oliver E. Graebner Ed. D.

PART VII OUT-REACH TO FAMILIES. A PROBLEM SOLVING PROCESS Mary Jc Weiland, ACSW and Carolle Bell, ACSW 67

PART VIII SOCIAL WORK TRAINING IN THE HIP PROJECT Ralph M. Scheer, ACSW 72 FOREWORD

As I think about the HIP project at Austin StateSchool, now coming to a close, two mental images seem to recur. Oneis a picture of a ship moving forward through the water, but as the watersunite behind the vessel no trace is left to mark its passage. In line withthis analogy, there is concern on the part of a staff which hasworked conscientiously and with some measure of proficiercy and some signs ofachieving established goals, that the 'water' will close in after the passage ofthe HIP ship and no one will ever know that it wentby. Will programs be pursued, adapted to the continuing needs of residents and staff atthe institution or will they be dismembered and forgotten? Will there be aliteral 'this too has passed' said over the remains of the project? Or to follow the analogy of a human transplant, how can a newand lively organism, the HIP project, be implanted into an old andongoing organism, an institution for the mentally retarded, and notbe rejected? The experience at Austin was certainly not unique in thatthe project staff was forced to learn how and to what extent programsmight be introduced with some measure of probability that they would not besabotaged or dealt retarding blows by detractors. The responseof the institution probably duplicated what many others have experienced wherethere has been wide variation in acceptance, degree of cooperationand tit'-:ation of findings. Suffice it to say, the project is done. The reports are in. There are many postive programs and results to be discussed. The project was good to do and it was good to be permitted to be a part of it. The HIP staff has been able to see themselves in moments of detachment, and in perspective to know that several hundred young people have had a new life opened up for them through the project, that l-ome other workers at the institution have taken a new look at the entire task of rehabilitation and the role of the institution for special children. For a time the lock-step of children and y.1g people moving in silent shuffle from building tobuilding has been halted and many have moved out of this lethargy into community life. That is the story reported here in part. The papers run the gamut from a theoretical consideration of the monumental task of moving people out of 'human warehouses', to arranging outreach services so that families and agencies will help prevent institutionalization or will provide back-up for discharged mentally retarded. The first two papers consider the task of trying to move residents or patients out into community life. The third paper tells how attendants who work with residentsat their dormitories might serve as teachers rather than custodians and keepers. The fourth and fifth papers report on a special program of training arel education for a group of emotionally disturbed girls, applying abeha ilor modification model as the method of choice. The sixth paper describes a half-way house program for older women on the campus of an institution for the retarded. The seventh paper deals with the task of bringing resident and family together as part of a therapeutic and rehabilitative program. The last paper reports on the development of social work graduate training within the frame-work of a HIP project. L HOW CAN WE IIELP 40,000 MENTALLY RETARDED GET DISCHARGED FROM INSTITUTIONS? Oliver E Graebner, Ed.D.

II 2. A NETWORK OF RESIDENTIALPROGRAMMING TO FACILI- TATE SOCIAL REHABLITATION Ralph M. Scheer, ACSW 3. TRAINING AITENDANTS TO BEDORMITORY TEACHERS OF THE MENTALLY RETARDED Sharryl Hawke, M.A. 4. PROGRAMMING FOR EMOTIONALLYDISTURBED, RETAR- DED CHILDREN IN A BEHAVIOR MODIFICATIONSETTING Sharryl Hawke, MA. 5 THE TREATMENT UNIT: A TOTALTOKEN ECONOMY FOR DISTURBED RETARDATES Robert Conrad, M.A. 6. POST OAK VILLAGE CAMPUS HALF-WAY COTTAGES Oliver E. Graebner, Ed.D. 7. OUT-REACH TO FAMILIES, APROBLEM SOLVING PROCESS Mary Jo Weiland, ACSW and Corrolle Bell, ACSW 8. SOCIAL WORK GRADUATE TRAININGIN THE HIP PROJECT Ralph M. Scheer, ACSW May I commend to the reader the papers heregiven, because they have grown out of individual andcollective struggles with many aspects of retraining younger and older men and women for lifeoutside the institution. The clearest mark of HIP project success is the record ofdischarges, the number of those who are successfully makingtheir way in ordinary society, 197, which is three times the rate ofdischarge in a previous similar period of time. The rate of failure has been 1%. My gratitude to the staff who stayed with the projectto its conclusion and for their carefully written reports of philosophy andpragmatic programming for the benefit of residents and staff.

Oliver E. Graebner, Ed. D. Co-Director, HIP Project

111 PART I

How Can We Help 40,000Mentally Retarded Get Discharged FromInstitutions?

Oliver E. Graebner, Ed. D. Co-Director, HIP Pro lett A great push is now on to get residentout of in ititutions. On the one hand, a few very vocal and institutions. here-and-now prestigiousleadersarecallingfor ashut-down Now,let us get down to a eurren their very problem; namely, how can we help the 40,000mildly ofallinstitutions. They contend that of existence predisposes society to eping thousands retarded move out of institutions, with some sert behind walls who should never be placed thee.e, and defensible rationale and with some hope of success, We believe that the answer lies that their very existence guarantees the perpetuation once they are out? the complex of professional and lay community ofallthelimitingfactors whirhsurround those in roof flattened leadership, and in the jointly developed programming assembled under theinstitutional people, affect, lowered aspirations, emasculatedrisk-taking foo discharge of residents (children, young talents. middle aged).It lies, hopefully, in those programs and the prevention of the use of gifts an through the leaders, which are planned and put into action Unless we take extreme measures, say these efforts of those who work directly with clients,that to shut down all institutions forthe retarded, wc will is, thechild-careworkers,attendantsandth,-ir beaiding and abetting thoseforces,public and informal, supervisors who work at dormitories and cottages_ private, individual and collective, formal and of the contribute These workers have the knowledgable support which rob individuals of their birthright and superintendent and his staff, (psychologists, social lifeof unproductive dependency. toa regimented workers, physicians, vocational rehabilitation coun- state's Mental On the other hand, since the Kennedyphase of selcrs), and the central office for the public awareness of the mentally retardedand the' hIealth Mental Retardation services, and, outside growing efforts for their rehabilitation(such as com- theinstitution,the parent greups, business organi- munity action programsfor the retarded) sonic pro- zations,service clubs and churches. fessionals and many parents have organizedduring the l960's to prepare as many as possiblekr productive The Parents life outside of institutions.Toward this end, they have actually moved many retarded'rout confinement Some parents naively expect theinstitutionto to freedom, from rockingchairs to walking on their worka miracle with theirchild. They need only own two feet, fromthe status of indigent, helpless bring the child to the school or hospital and the good patients to lively citizenship.We predict that the people will "make Mary well again" Perhaps a way debate over how and when to closeinstitutions will of teaching, or some kind of pill or treatment will be waged during the 1970's. But,what are the prob- help Mary overcome her silly talk and her failure to lems in moving young people outof institutions into read, spell or count numbers.While waiting for the the mainstream of Americanlife,and how can we miracle to take place, they are willing to have the cope with theseproblems? institution keep their child.

Granted that there are children and older people Some parents, deeply disturbed or disappointed by the presence of their mentally retarded child, turn whowillcontinuetorequiretotalhospital care multihandi -.capped, or him over to the institution to keep him to keep because they are bed-fast, Christmas or have extremely limiting factors which call kr special- him for life, out of their lives (except at Accepting the hypothesis, that birthdays, when he goes home for a visit).They ized medical care. leave for the 75% of those in institutions for the retarded insist that he stay there where he cannot really for whom it would be better not to live in what some andwhere theyare not always remindedof him. have called "these hum:1n warehouses" or even in Rejected? Yes. Totally? Well, almost. well-appointed training :.enters,but scattered over Some parents, not as calloused, not as rejecting, theland,inprivateor cap homes,in ordinary houses, on ordinary streets in Maine or Iowa, assum- still sensitive to their child's needs, fear his return for more than a day or ing these all should be i.tioved 03 quickly aspossible, to their home and neighborhood there are still problems of legisrics which no oratory two at a time.Their retarded daughter might make living quarters, jobs, food, some friends with boys living near will they take ad- will waive aside: The minimal care by others,notto say,relationships vantageof her; how can she be protected? to manage at13; now familiesand neighborsand, not to be retardedson was difficult withtheir who could manage to overlooked,the problems of family and community he is 21, large and strong restrain him if he got out of hand or had oneof his acceptanceof those who were formerly living in 2-- As thinks the superintendent, so will think, in time, spells?" his staff, especially if his tenure is longer than the Some parents really love their retarded child,and usual year or two. they are happy for his growth anddevelopment, his signs of self-care and the beginningof good wark I. Onetypeofsuperintendentconductsthe habits.They think and say, "How well he is doing, business of the inetitution as an "old-line" admin- how much you have done with and forhim!But you istrator. He has grownto accept the institution say we should take him home after all these years? as it is.He sees his job as preserving it and passing We should rearrange our lives andfit him in,per- it on to his successor, intact, or at least,with as manently? That's a big order. Can we do that?How few changes as possible, with one or two improve- will he really fit into our live ments preferably in physical plant.In his way of thinking he rules well if he ean reward those who do not engage in "boat-rocking."In fact, he removes And,there are homes where only one parent is fromofficealltheboat-rockersand innovators, present,because divorce or death has broken the They really do Is it really feasible or wise for son or daugh- because' 'all they do is make trouble. circle. not know how to do theirjob:' He views the insti- terto go home permanently and livethere either minds, without a father or without a mother to guide and care tution as a kind of repository of sick bodies or or both. One type of librarian may seeher job as the for him ? protector of books and be mostpleased when she sees the shelves well filled; in the same sense a superin- The attitudes of parents of retarded ch;ldren are tendent may estimate his success by checking the probably not different from those with normal children, AWOL list, watching how residents walk two-by-two but in each there is noticed varying d.zgrees of accept- in straight lines when out for a walk onthe grounds, ance and rejeetton,of love and hate, of sympathy whether they greet him as "Mr. Superintendent," and, anddisregard,offear and distrust,of guilt and ifthey don't get pregnant.The worst thing that self-pity in relation to their retarded children.Ask has those who counsel with the parents as they first could happen is to find that a department head signedform B instead of B17 toorder ping-pong learntheir childis retarded or asthey consider balls,orthat the Nursing Department instead of bringing him to an institution. cottage Life'ordered band-aids. If we set ourselves to the task of programming the 2. Thenthereisanother superintendent who dischargeof our residentsorpatients,our first what resources does the likesboat-rocking, in fact, he is a champion boat- considerationshould be, rocker, without keel or ballast.Re listens to no one, home provide?What does he have to come home to? and his idea of counseling with staff is to callthem Who is thereto help parents receive and properly Lacking in 9 n d give them orders.He has a way of alienating guide the returning member of their family? the staff by giving them individual tongue.-lashings a suitable' home, will parentsinterfere with their son for their have been discharged? whileconducting generalstaff meetings er daughter's life, once they failure to perform to his standard.Recently he has Someselfish parents are glad to have their child taken a personal interest in the statistics ofdis- home as long as he brings money into the household There charge.He is so intent upon making a good record coffers, as long as he does well on the joks discharges from hisinstitution that he has in are instances where parents havecaused the visiting of or discharged young man or woman to getinto trouble effect taken over those departments, social services, call the insti- psychology, medicine, who are vitally concerned in so that they, might have an excuse to each candidate for discharge.He insists upon push- tution and to send them back again. ing for the discharge of borderlineand questionable cases; he applauds anyaction that holds the gate The Superin endent open for residents to move out,regardless of their productive capacity Without question, as in other organizations, an current behavior record or their institution such as a school or hospital is thelength- and quality. ened shadow of its dominant figure.Among schools for the retarded this is usually the superintendent, 3. Occasionally, you will meet a superintendent thetop administrator who operates theinstitution, who seems to operate on the rule, what will advance usually under a board of professional and lay people. me? The office of superintendent rules the man, at

7 the same timeit must serve his personal interests. The superirtendent. on ha part. holds tremendous The progress of the institution is measured by .how discretionary powers over his staff and their act:vi- themost important much he is advanced in prestige thereby.All efforts ties. Heholdscontrolover theinstitution, must in one way or ariothr endorseand promote his contineenciesandtherebyshapes like salaries, advancements, appoint- rise to distinction.He watches carefully to identify contingencies ments to new positions, the development or decelera- the new method of treatment.If the current fad is to as rapidly as possible. hewill tionof programs and services by applauding some discharge as many while ignoring or playing down others.If the super- not be left behind. Or. if the current fad is topractice intendentisconvincedthattheentranceto the behavior modification in the treatment of undesirable looks decrepit and out-moded,he very behavior and to teach desirable conduct and skills. institution likelywill be able to locate.the funds to beautify he will not be outdone. He will out-shape the shap- If his concern is for the development Lacking discretion, that gateway. ers,ifthatwere possible. of innovative programs for the benefit of the residents, without rationale or plan. he istoo busy watching first and foremost, this will beE! the main thrust and his own score on the great board of some central vital concern of his communications.His business of lice. managerwill getthe message,'' andallothers As someone has said,"there is a little larceny in will catch the new perspective of the boss. each of us;" and another, "he that is without sin, let Parenti with a retarded If many .;,oung people should not continue to live him cast the first stone." in institutions then we must consider those minimum child have a serious and difficult task on their hands. conditionswhich mustexistinordertohave a They need all the symrathy and genuine assistance reasonableassuranceofseecessafter discharge. we can provide.Likewise, the role and task of the Here are some of the more pressing needs and con- school administrator is a lonely onc.The pressures ditions, with emphasis for the moment upon our two which impinge upon him from the "outside" ean be favored chi.racters,parents and the superintendent. shared at times with no one.Ile must carry on with optimism and hopefulness when there are few signs We can dischargewith areasonable hopefor to support it.His is a round-the-clock vigil (on and success outside theinstitution when the following off campus) of children and staff under his direction. conditions obtain: 1) Parents will operate within His humanity is just as much on the line as that of an attitudinal frame of .7eference,whether implicit or parents and the people who man his programsand explicit,which includesa willingnessto receive keep things running.He feels deeply the disappoint- their son or daughter in their home and neighborhood. ments which dash the enthusiasmof a group who They have the attitude, as though to say,`` we won't will not receive the funds to carry on a sorely needed know what our Johnny or Barbara can really learn improvement; he feels just as confused and frustrated to do, at home or on the job, but, wewill help open as his staff when the press or alegislator or a neigh- the door and let them Lry.We believe that with our borhood store-manager misinterprets the best efforts confidence behind them they will go far.How far, we to train and treat retarded children withthe means at will let time tell."Parents will thus have reasonable hand.Anyone who has spent hours in the "super's" expectancies of their child, with some understanding office has much sympathy with his post, its trials, oftheir limitations and assets.They will expect itsdisappointments anditssmall glories. That successes and failures inkeeping with the progress person will be the first to say, more power tohim, he achieved. 2) Parents will move them insofar as needs and merits our best, our loyal support. possible into the mainstream of normal life experiences. They will provide contacts for the retarded health and We have thusfar observed that thetwo most with a number of agencies necessary for important variablesin moving residents or patients safety police, fire department, doctor, nurse, mini- toward discharge are 1) the parents, and 2) the super- ster-priest-rabbi, employer, batik, shopping centers, telephone. intendent. The best laid plans of community and and the ability to use that vital link, the their institutionwill fall apart and prove ineffectualif 3) Parents will utilize the services offered by parents take a negative view of their son ordaughter's community for the social, economic, religious,and Where these are discharge,ifthey_ reward his successes with de- personalgrowth oftheirchild. precations or malevolently insure his failure on the deficient or absent they will work to helpestablish job or in leisure time pursuits.Parents are crucial or strengthen them.They will seek counsel regarding in planning for discharge. special problems.Shall my retarded son or daughter 4 marry?Who can predict the quality of life in their peddlers of doubt and those who forget their mission home, if they should marry?If marriage is considered, because they are so power-driven.Their signs of how shall the sexual problems,like reproduction, disruption and confusion-mongering are noted;they and desist. They be handled? Will parents seek out good advice? are given fair warning to cease Are there reasonably safe guidelines to aid in coming are invited toredirect their energies into constructive ready to to grips with problems ofsterilization, or the use of work with those residents who should get thepill,or injection?Is there help regarding the move out. moral and legal aspects of marriage by the retarded? How can we get 40,000 mentally retarded who are institutions discharged, with a Beforethepersonisdischarged, many events presentlylivingin have transpired within the institution whichaid or more than 50-50 chanceof success? May we describe for the day hinder him as he prepares for 'life outside."Here, two kinds of programs aimed to prepare programs tode-insti,utionalize asnoted above,theleader ofthat organization, ofdiseharge: I) program:: to help prepare forliving namely,thesuperintendentagainloomsasthe residents, and 2) dominantfigureinthe matrix of movement to the outside the institution. frontgate. After a person has lived in a traditional institution for a number of years, it is difficult forhim to adopt 1. Preparationshave been made beforedis- the self-motivating and choice-makingrole of those charge. Under the leadership of the administration Ile has learned the institution has caught the new look thinking and who reside in the ordinary community. to be dependent uponothers to answer all his ques- planningis along the lines of treatment, not mere not) and to receive custodial care, training and education, not regimen- tions(whether adequatelyor ready-made goals to strive for and a shove to get tation and incarceration. The staff worksin the clean, well- started. Therefore, before being released from an confidence that residents can learn to be effect, groomed, quiet at times, good to havearound. institution a beginning must be made to in de-institutionalizethem. Thistaskisdifficult because those who work at an institution arethem- 2. The staff is encouraged to develop a life selves caught in the same web of language, systems, planfor each resident, a plan which callsfor as much movement as possible toward the onegoal, procedures,paper work, andz.iministrazive gobble- indischarge, degook which surroundsall who live and/or work independence,orsemi-independence residents kills and peri,Dinal qualities which will there.Any program which seeks to prepare withthe to get out of the institution musttake into account make this possible. theattitudes and usual managementprocedures of the attendants or child-care workers.If necessary 3. The best minds of the institution, regardless consider and they must be led to rethink theirjobs. Are they of title, training or rank, form a team to Do they regard long-term problems, primarily keepers and custodians? give feedback to current short and well as models with proposed plans and solutions.The staff is so themselves as substitute parents, as findings of behavior, as leaders, trainers,teachers, guides? organized that they can accept and implement they regard their role and task, sowill they and programs of the team.Parenthetically, it should As that work with conduct themselves in vivo.All staff members, in be noted, that it is an error to think their tasksinthelight the retarded requires the least intelligentpeople to short,should re-examine be successful. Quite to the contrary,the best minds 'of 'contributing to residentdischarge. ingenious methods and pro- are needed to develop The professional members of the staff also should grams to modify learningof all kinds, with the re- vantage point, There is considerthesituationfromtheir sultant improved behavior and performance. how can they plan to assist the attendants, tothe thefurther observation,based upon repeated ex- single- end that the residents become less conspicuous as perience,that when a child with an IQ 50 members of the community? What changes in style of he can do to mindedly focuses his attention on what walking and talking, of dress and grooming will make make the "big people,"professional included, do "front out-perform all but them less noticed as they walk through the for him, he can in his own way gate?" Together with programs to improve their theshrewdest. appearance and manner,supported by learning self- the superintendent has dealt with respect because they aretreated with respect, there 4. Finally, habits, the forces of gloom among hisstaff, including the will be needed training in acceptable work

9 occur when developed on the job.Training in marketable skills, anotherdiscussion,problems which using common tools, whether in thehome or out-of- parents are deceased or when there is nohome for to,or, where but one parent doors,willfurtherthe cause of rehabilitation hy the retarded to return making them more valuable as potentialemployees. ispresent, or where the socio-economicconditions preclude a favorable environment for even marginal tkerealizethatthere are many variables other support for a retarded member. thanthetwo under consideration whichinfluence the outcomes of discharges. Besides the parents Steps Toward Discharge and the superintendent there arc community expec- from tations,general andimplicit,expectations by em- The movement of residents toward re ease ployers and by vocational counselors, as well as the lifeataninstitutionisdescribedinFigure1. taboos and mores of city and country neighborhoods which all who reside there, including the retarded, When has readiness for discharge been achieved? must learn to cope with and accommodatethemselves. What are the significant marks of training and per- tobeobservedand checked? fn thepresentconsideration we areholdingfor sonalperformance

Figure 1.

STEPS TOWARD DISCHARGE

From Institution to Community Life

Economic ---4.

Communityii

Work ....-0, Skills

Social I

P rsonal ---, _

Personal PersonalCan and Wants Know.: His Way Can Manage Development Social Growth To Do a Good job Around Town His Money

-6- Figure 1. postulates a five-step progression. been lost, concerted effort needs to be made to insure their return to all mental retardates, including those Step L " Personal," covers all areas related to who are about to join the world outside the institution. the person physical appearance, grooming, dress, These rights include the Bill of Rights, freedom of otal self-care skills; also, acceptance of selfand movement, freedom from discrimination in employment, management of self; a beginning ability to useleisure housing and services.Since in most cases MR's time. arenaive and uninformedin most of these areas, theyneedcarefidand concreteinstruction before Step2. Social,'includesallinter-personal theyleave the institution. contact skills appropriate communication, respon- sivenessto others, triendship formation,willingness Step5. Economic," refe stoall aspects of to participate and contribute;growth in ability to use income and expenditures involvedinliving in an leisure time in the company of others. independentor semi7independent home. This in- cludesthecareand managementofearned and Step3.' `Work Skills, refersto generalized gratuitous money, the ability to live within an income, attitudestoward working under the direction of a thewillingnessto accept and follow counsel in stranger, readiness to follow theboss's directions financial matters; a growing sense of responsibility regarding given tasks.It means the ability to remain for all aspects of cost of self-care, both short and ata taPk for sufficientlylong periods of time in long-term.Personal safe-guarding of cash on hand, ordertobeproductive,cooperationwith fellow the use of banking facilities, investment in day-to-day employees, flexibilityin carrying out workssign- as well as items of greater cost,the development of ments. a rudimentary end minimum budget. In addition to desirable attributes, it includes the He needs a sense of responsibility and apprecia- development of marketable skills cleaning house, of wise use of income as the necessary base washing dishes, doing laundry, serving food, servic- tion forallindependentliving. Scme understanding ingaear,changingtires,delivering messages, of the process described as the willingness to ex- mending or changing garments, clear ing and pressing change personal effort for wages; in the development livestock), mowing clothes,tending animals (pets, ofcredit rating and a reputationfor honesty and lawns.All of these skills can be learned within an dependability in financial matters. institutional setting. Step4.' 'Community,"referstoallordinary Who is ready to leave the institution?Learning contactwith a neighborhood knowing his way tocope with the demands of lifeoutside the in- around the immediate area on foot, and the larger stitution is in many ways similar though in a reverse community, via public transportation taxi, bus, or fashion, to learning to adjust to life within an in- directing the driver in a private car.It refers to stitutionwhen first entering.No one is prepared experience in shopping for personal items as well by himself to cope with all problems and situations as larger investments, knowing how tohandle their which occur in normal living in a community; assist- own money, depositing and withdrawingfrom a hank, anceis needed at times hy the great majority of mattersofpersOnalsecurity(identificationcard, citizens..It should not surprise anyone that retarded whom to ask for helpitlost, how to speak with youngpeople who havespent months and years police or other public service employees); having a withintheconfining and restricting milieuof an rudimentary knowledge of their right under the law, insiitution should also require assistance in prepar- knowing how to conduct themselves in public as- ing to move out into society. semblies or meeting places church, theater,res- taurants, tours of fairs, museums, public buildings, Readinessfordischargeandindependentor swimming pools, amusement centers."Community" semi-independentlife may be approached from the means making a beginning of social contactsin the check-list which covers thefive areas described community, it means a dependable use of leisure time. above,Personal,Social,Work Skills, Community, and Economic preparedness. Those who would move out of institutionta should be aware of their rights as citizens and should have How far has he progressed in self-care how learned how tolive with and within these rights. does he appear on the street, in gait, in dress, in Sincein most institutions many human rights have public 'manners?" What must he yetlearn to 7 11 enable him to be more comfortable when moving about institutions are seeing the beginning of a newera Following inthe community? for mental retardates intheUnited States. the Scandinavian developed principle of normalization, Has he developed some ofthe ordinary social inquiries are under way in some United States com- skills which enable others to accept and interact munitiesregardin6 therole and functionof these with him?Are there still important aspects of his "human warehoines."Here and there across the social life which are seriously deficient or inwhich landprogramsto trainor retrain young menand helacks control? women for useful lifeintheir home town orin a suitable community are gaining momentum. How well is he informed about the neighborhood stores,health and safety services,religious and Twosignificantfactorsweredealtwith,the recreational centers? Has he had experience off- parents of mental retardates and the superintendent campus, singly or with others? ofinstitutionswhere many mentalretardates are living.In order to insure a reasonably good chance Has he held a job off-campus?What is his work for a successful discharge and the movement of MR's record, and what are the reasons forterminations? to their home community, parents cansubstantially Has he learned any particular jobskills?Are these aid or hinder this event by their attitudes and conduct feasible where he wants to live?Has he been de- toward the retarded. sensitizedagainst name-calling? Can he follow is fin- work orders and stick with the jobuntilit As chief and director of all that takes place in an ished? Has he learned to live within certain monetary Does he have institution,the superintendent likewise may signi- limits, can he live within a budget? ficantly aid or hinder the preparation of the retarded trusted person who can and will access to a friend or toward discharge.If he is courageous and is con- guide the economic aspects of hislife outside the savings vinced of the potential for a reasonably happy life institution? Has he saved money, what is his outside the institution for about 20% of the population the time of discharge? account or trust fund balance at inhisfacility and if he leads his staff in their preparation, remarkable things can happen.If he is Warning: A mentally retarded residentis not fundamentally opposed, whether out of fear or due to readyfor discharge if: reports of some failures or to some a-priori judgment, hisstaff will act accordingly. 1. He has no regular job off-campus. 2. He has no satisfactory living place. 3. He has no person who will aid him in the Finally, a hierarchy of preparation for discharge community. was presented, called,Steps Toward Discharge.ft is 4. He has poor work habits. proposed that unless the resident living at an in- 5. His parents do not want him at homeand stitutionfortheretarded has made considerable other plans have _not been worked out. progress along and up these steps Personal, Social, 6. The police are looking for him. WorkSkills,Community, and Economic he is 7. His current behavior is maladaptive in the ill-preparedandhisreleaseshouldbe delayed. community where he proposes tolive after discharge. The discharge of residents can be quickly ar- 8. he knows littleor nothing about the com- ranged on paper. The institution, if organized toward stores, munity transportation,banks, meetingthisobjective, can effect a reshaping of churches,laundry, recreation. many behaviors of the residents inpreparation for 9. He has not been off-campus by himseL.,for release.When they have been trained or retrained, orother ac- work,shopping,recreation, resocializedandreoriented,their successful dis- tivities. charge depends upon how they are received inthe community, beginning with the place where they go to Summary and Conclusions: live, whether at home or half-way house, hostel or The rush toward the front gate of many institutions group home. In addition, how potential employers especiallythoseworkers who forthe mentally retardedis well under way. An viewtheretarded, arousedcitizenry,parents,legislators,headsof still show signs of institutionalization, how fellow Mental Health Mental Retardation Boards, and of workers regard and treat them, is of the essence. 8 Itcan be done.In some places in every state, nificant aspects oflifethey are listed as equally selected men and women, young people are being valuable and as occuring in sequence.A trial ap- dismissedfrominstitutionswiththe good wishes plication as a rating scale will illustrate its utility. ofthose who have worked diligently onbehalf of their rehabilitation.Their record in the majority of When the scaleis applied to a given person or cases is favorable.One program of intensive social- groupofcandidates who arc being considered for izationin a Texas institution has resultedin the discharge, areas of strength and weakness may be discharge of 250 men and women ages 18 to 35 in identified. Omissionsorfailuresin development four years, with less than 2% return to theinstitution. maybereviev,cdandappropriatestepstaken. Suchdischargesrequirenomagic,althoughthe results in some cases appear almost to be magical. For example, a given candidate, we will call him four areas (Per- itrequiresknowledge,and courageous,forthright John Jones, rates high on the first action. sonal, Social, Work Skills, Community) but has just beguntodeveloparudimentarygrasp r-11 money Some programs for discharge emphasize behavior management. Can he be discharged?There is a shapingorbehaviorreinforcement,othersarea relative in the same city who has offered to assist in combination of counseling and milieu therapy where monitoring John's finances. Dischargeis agreed the total environment is arranged tofacilitate desir- upon. ableconduct and performance. But inall cases, successfuldischargeresultswhenagreat many For each aspect of the candidate's life which has details are given attention by many people, beginning not reached a satisfactory level there must be pro- at the residential centers where therete.rded live for visi,,nsin the community to fill the gap.This too a time and, afterdischarge, the attention given by has its limitations.Self-care skills and the deve.op- concerned and sensitive persons inthe community. ment of the social sense and of social skills appear to be sine quae non for anyone expecting to move out Figure1 assumes that each of thefive areas. of an institution.These should be well-developed isequally important.Whether each isequally im- because they form the base upon which the other three portant for all people is a good question.For pur- willrest communitylife,job skills,and money poses of emphasis and in order toinclude all sig- management.

READINESS FOR DISCHARGE SCALE

Directions:Consider how theresidenthas developed ineach of the five areas of growth and experience. Make a check mark M along the line from 0 to 20 for each area. Your check mark will indicate how far the resident has moved from dependence upon others to independence.Ifthe resident requires total help, place your check mark at "0";ifhe requires no orlittle help, place the check mark at"20".If his need for help lies somewhere between the extremes,place a mark where you think it should be.

MARKALL FIVE AREAS IN THE SAME MANNER 9 13 DEPENDENT INDEPENDENT Requires Requires Little Total Help Or No Help

5 10 15 20 1

I. PERSONAL self-care

2. SOCIAL , Personal-Social Growth I

3. WORK SKILLS Can and Wants To Do a Good Job

4. COMMUNITY Knows His way Around Town

5. ECONOMIC I Can Manage His Money I i TOTAL

B BLIOGRAPHY

Albee, George W. Needed A revolution in caring for the retarded. Transaction, 5 (3): 3742, 1968.

Clark, Gary M. A state-widehool-work program for the mentally retarded. tal Retardation (AAMD), 5 (6): 7-10, 1967.

Cleland, Charles C. Intra-institutional administrative problems: Employee communications. Training School Bulletin, 64 (3): 81-91, 1967.

Graebner, Oliver E., Meyen, Edward L., Schultz, Esther D. "A Resource Guide in Sex Education for the Mentally Retarded,"SIECUS, N. Y., 1968.

Hodges, Brian E. The future of mental subnormality hospitals. Nursing Mirror, 126 (9): 22-24, 1968. continued

0- 14 BIBLIOGRAPHY continued

Kirkland, Marjorie H. Institutir for the retarded: Their place in the continuum of services. Mental Retart., Jr1 (AAMD), 5 (2): 5-8, 1967.

Lent, James R. Mimosa tage:Experinr.-ntinhope. Psychology Today, 2 (1):51-58, 1968.

Lobon, Robert R. A proposed model for a comprehensive vocational habilitation program for institutionalized mental retardates. Project News of the Parsons State Hospital and Training Center, 3 (7): 5-14, 1967.

Neuhaus, Edmund C. Training the mentally retarded for competitive employment. Exceptional Children, 33 (9): 625-628, 1967.

Scheer, Ralph M., Hawke, Sharryl, and RJc, Norman G. Community Preparedness for Retardates, Austin State School, Austin, Texas, 1969.

Sloan, William New diensions in administrati n. Mental Retardation (AAMD), 5 (5): 3-6, 1967.

Stedman, Donald J. Intermediate step planning for mental retardation programs, Mental Retardation (AAMD), 5 (6): 28-29, 1967,

11 15 PART II

A Network Of ResidentialProgramming

To Facilitate SocialRehabilitation

Ralph M. Scheer,Acnv Social Work Specialist E. Hu rodue t ion implement socialization program.

Largestateschoolsare designedto transcend Ever so stronglyletitbe emph'zed that this such dimensions as age, sex, intellectual and social cottageendeavor isnotone which couldonly he functioning levels. Few institutions specializein broughtaboutby o specializedstaff.elaborate treatment of severely or profoundly retarded;however, equipment or anything else beyond the scope of any most are generic.This noses a great administrative institution. This oft-used rationalization does not dilemma. How itisfeasible on the one hand to hold wate,. servicealargepopulation sometimesranging between 2,000 and 5,000 persons and at the same time This paper will focus upon thc efforts inade in the streamline program services to challenge each seg- last two and one-half years in efforts to use cottage ment of the popuiation.Unfortunately, management activitiesinacomprehensivetreatmentprogram. oftenhasnotsuccessfullysolvedthisproblem. Ironically, themii, retarded arethe very group A. Population most hampered by the system.Rules and policies effecting the total living milieu are set up primarily Thirty-one male residents liveat a pre-discharge withthe more handicapped retardedin mind. For building Juniper, No. 729. They are mildly retarded example, although a resident may work full time in the and young adults.They have been at the Austin community,he cannotcarry matcheswhile.at the State School for several years Although most have School.He may drive his parents' ear during Christ- in the past, or are currently holding community jobs, mas vacation, but is not allowed to use the telephone many are classified as behavior problems. at the institution.These paradox, in experiences and opportunities strengthen the doubts of self-worth -Walnut Cottage (No. 6A) is stcppiog stone which already exist on the part of the resident.The to Juniper Hall.Here live 28 young adidi mildly and young adult 7ctardate has concerns about marriage moderately retarded fellows.Almost allre working and family life.The staff paradoxically discourages intheinstitution. They intellectuallyiv socially even normal social contacts ,,iththe opposi.,e sex. havenot been exposedtothe expuriensof the Often the resident matures in spite of staff efforts No. 729 men.Also many behavior problem idents ratherthanasamanifestationofthese efforts. residehere. Together these cottages Whatthen can staff doto arm theretarded with bridge from custodial care to community re, osis. arsenals of experiences which will equip them to be preparedforcopingwithsociety'sexpectations. B. Foci ities Rather than focus on any one aspect of programming itis the intent to share with the reader a potpourri of ideas whichreed to be intricately interwoven to No. 729 is a ranchtype building withits own provide a network of residential programming both in kitchen, dining area, lounge area and bedrooms which both in the institution and in half-way house place- sleep 3 to 4 persons each.lt offers excellent out irn en ts. door recreational space.in general, it is quite a quateforprovidingasoundliving environment.

II. Setting On the other hand, No.6A building is much older. Ithas little outdoor area. Itis located above the The Austin State School,typical of scores of main institutional kitchen, which makes it quite hot other State schools throughout the country, serves during the summer.In many respects it fulfills neg- allages and functioning levels and has ties to a ative expectations of an institutiorul facility.Few custodialpast. Itlikewiseisaninstitutionin changes have been provided to improve the surround- transition.In the last several years soul searching ings so it might provide a more adequate environment. hastaken place in an attempt to riditself of the This cottage is divided into bedrooms for 3 to 4 per- limitationsof custodial care and re-focus upon the sons. An insurmountable program problem is the lack challenge to re-examine its role.A Hospital Improve- of out-door or in-door living space. ment Project grant was obtained.The task of this grant: "to cope with the growing segment ofin - C. Staff stitutionalized, mildly reorded manifesting socially inept behavior through an inter-disciplinary team to Both No. 729 and No. 6A are staffed by one 13 attendant for each of the three .shifts with relief being in decision making, handling conflict and taking re- rotated between the two buildings.In total, there are sponsibilizy, thereby moving in as rapid a pace as he 9attendant staff,one supervisor, and one social comfortably can manage toward moving into the corn- worker, which make up the assigned staff. munity and eventual discharge.

Philosophy, Objectives and Goals It is felt that even with those residents where the prognosis is poor for community living, the goal must The strongest rationaie for providing institutional be to increase their potential so that these residents services rests in the ability to offer agood residen- can live full productive lives.Why must retardates tial program.The retarded person frequently is able be treated with less respect and dignity merely be- to be served by the special educationteacher, social cause they reside within a protectedenvironment? worker, psychologist, or vocational counselor inthe For those who have failed in previous rehabilitation isthe institution's unique efforts, the goal is to help by providing opportunities community. Then v.-;rat or traits contribution? Wheninstitutionalization seems in- so they can modify those characteristics evitablethe decision would logically rest on the which have denied them succr,ss. assumptionthataresidentialmilieuwould offer something different.The treatment orientated living IV. Advisory Committee environment is the unique dimension whichwhen properly used will hopefully expound andembellish the At the beginning,it was quickly realized that of efforts of a variety of professional services.This paramount importance were theattendant staff. It process could not and would nottake place if he were was evident thatit was crucially important that the living at home. gulf that existed between cottage staff and professional staff be bridge. In order to accomplish this, The cottage cannot function merely as a place daily bull sessions" wereheldbetweenthe where he eats and sleeps while professional per- program director, the attendantcoordinator and the sons are " therapying" him.Instead, the cottage attendant staff.As these cottage groups began to must function as a nucleus whereinhe can develop solidify in their identity, members of the professional characteristics which make him amenable toprofes- staff were gradually added. This was a slow process feeling sional services.But even if this objective were fully since we attempted to avoid the attendants realized,this would be insufficient.The cottage out of place and consequently "claming-up." environment itself can and must provide a potent rehabilitation tool. Gradually many people dealing with the residents were participating in weekly meetings.These infor- The objectives and goals for No. 729 and No. 6A mal meetings gradually were transformed into a group are in similar in nature.However, a great deal of in- known as the No. 729 No. 6A Advisory Committee. dividuality exists on each cottage.The main differ- ence of focus lies with the position of each resident along the habilitation continuum.Walnut (No. 6A) TheAdvisory Committee served asa staffing provides a " farm team" for No. 729.The primary groupto handle a varietyofindividual treatment objective is to furnish an oncampus living environ- needs of each resident.Secondly, the committee dis- ment wherein residents can test out their emotional cussed program developments effecting groups of res- feelings,deal with new social situations, and ad- identsor the total cottage.In this capacity they vancethoseskills which are requiredin meeting thirdly reviewed cottage policies and helped modify life's demands, both at the institution and in the com- the structure to bring it into alignment with thera- munity.An especially high priority is placed upon peutic goals.By being involved in procedural modi- vocational achievements. The program continually fications the committee was able to act as a sounding pushes toward the community rather than those ac- board to the total institution. tivities at the State School.Leisure time activities, work assignments, 'peer and staff associations should all be directed toward helping residents to test social In most respects the committee has fulfilled its reality while here. Now is the time to get the bugs expectations.It has established itself as an organ of out."A continuous push is made to help the resi- of communication between staff and has made it pos- dents broaden perspectives and interests, to engage sibletoengineer movement withinthe cottages.

18 classwork often bypasses many areasthat the non V. Pro ram retardate picks up through every daylife experiences. Staff Supervision A. The cottage staff, with assistancefrom a teaching of courses de- The most crucial factor in anycottage program is consultant, have developed a series and values can be signed to fill this void.Courses of four weeks du- the efficiency by which staff norms the young men of both made compatable with the programdesired.This is ratio-i have been held, with settings where ongoing cotti ges in attendance.Seven sessions are held us- particularlystressfulin aids, field problems, building coverage all buteliminates the opportunity ing lecture, discussion, visual No. 6A etc.The course is terminated with afinalexamina- kr formalized learning.En the No. 729 Several weeks only one staff per shift itbec:ame tion given orally to eachindividual. program to counter to avoid this becoming a essential to provide staff trainingthrough informal are allowed between courses helped to counsel boring experience.The following courses have been approaches.Attendants have been Educa- joining with pro- completed:Personal Care and Grooming, Sex residents more therapeutically by tion, Communication andTransportation, You and the fessionalstaffinjointcounselingsessions with of Leisure Time, handling crisis sit- Law, Current Events, Dating, Use residents, especially in jointly Vocational Pursuits, and MoneyManagement. uations. The attendants serve ascoteachers in adult education classes.They participate in and ff serve as lecturers and student government En all courses cottage sr sharetheroieof advisorto En addition, many small groups They actively help the residentsplan and discussion leaders. groups. of 3 to 4 residents areassembled by the attendants evaluate social activities.They take an active role signing signatures, The cottage it- and helped with table manners, in all facets of cottage programming. learning to telltime, handling money andlearning self becomes the attendant'sraboratory.A partaer- ship is formed between the programdirector, the at- how to ride bikes. wherein pro- tendant coordinator and the attendant, These courses and activities aredesigned bas- gram responsibilitiesdrift down the staff echelon as attendant staff becomes skillful enough to assume ed upon their value in communityliving. task these tasks.When the attendant ansumes full Meetings responsibility the supervisor and the programdirec- 2. Student Government and Dormitory for supervision and consul- tor are always available Each week a compulsory meeting onthe cottage is tation. held with residents of each cottage. These dorm meetings are designed todiscuss cot' -igeand in- It has often been said that theattendant should stitutionalpolicies, plan and evaluate social pro- get involved in program areas;providing /the oppor- gramming, and these meetings also serve as asolidi- tunity for him, however, isfrequently absent.This fying instrument for residentsand staff.Initially, opportunity must include a milieufree from reprisals rather than to establish a student governmentthe infor making honest mistakes.Helping attendant staff tent was to provide avehicle wherein residents could to feel that theircontributionis valued and relin- learn to talk in groups to each otherand to staff in a quishing responsibility as skilldeepens,is neces- meaningfulway. Each cottagegroup expressed sary to the ultimate success-of any cottage program. gripes,planned social activities, and ingeneral, This does not come quickly, but without it,the found- were exposed to adecision making process.As res- ation put down is like bricks without mortar. ident skills in these meetingsincreased they elected a chairman.After a time they decided to set up a cot- regular monthly social dues from IntraInstitational Programs tage "kitty" with B. each man.This soon led to financialindependence from the institution for more,yfor social activities 1. Adult Education and special programming. time Usually several years elapse between the developed hisformaleducation and Gradually as a back log of experiences theresident 'completes they moveil into the area of student government.They when he returns to the community. Duringthe interim made to avoid it, held elections and set up their ownjudicial system unless a conscientious effort is for handling certain cottage much learning is lost.In addition, special education whichis responsible 15

1 0 offenses. -.II too frequently administration promotes maturation occurs.These experiences must add to establishment of student ;government but soon become the resident's repertoire of skillsin making a tran- threatened when resident groups clamor for change. sition tQ ere community.In planning, executing and Thns,itis paramount that staff realize the conse- evaluating social activities the total gamut of group quencesof settingtipsuch groups. Sonieof the dynamics are used.Decisions are made, leadership changes which cottage governments have been respon- is assumed, conflict is handled and values are es- sible for bringing about are:A set of'rules to live tablished; all invaluable social skills. by governingresidentwork responsibilities,de- struetion of property, wake up time, telephone use, 4. Community Responsibility downtown passes, town shopping, use of the Canteen, s:ck time, rules governing bikes, and policies allow- As the residents began to feel a sense of pride ing resident possession of lighters. and genuine selfsteem they were able to assume the role of giver on occasion rather than continually The involvement of residents in the various pol- demanding. This opportunity was particularly need- -governing their lives has resulted in eliminat- ed as there is very little built into the structure of ing the feeling that they were without voice in respect institutionsto allow residents to give to others. A to what happens to them. Today when a resident runs high program priority for the No. 729 No. 6A pro- headlongintocottage policy,thestaffis usually grainhasthuscenteredaround the opportunity for supported by the majority of residents. community services.They have given Easter parties for younger boys, have built recreational equipmentfor 3. Social aml Recreational Activities milerresidents, and have served as volunteers in assisting the administration. The net result has been The men have beet, ex remely active insocial- that they have felt that they had an opportunity to recreational programming. The attendant staff has be a contributing member of the State 5,2hool com- helped as chaperones and in providing resources such munity. The next step is to go beyond the institu- as transportation but financial costs have been borne tional framework and help them offer service to the bythe residents themselves. Activities cover the Austin community. spectrum of both oncampus and community pursuits. The men plan the activity, do the decorating, invite 5. Cottage Work Projects their dates, select their chaperones, make refresh- ments, do their shopping and pay their bills.The Another tool which effectivelyis used in facil- staff help the residents evaluate these endeavors. itating the transition to the community is the cottage The resident's skillin this area has grown tremend- building itself.The staff often create an inconsist- ously. Some of the activities have been: cottage ency in how they view the resident as relating to his dances,birthdayparties,tripsto Six nags Over cottage.On the one hand they reprimand the resident Texas, Hernisfair, a plane trip to San Antonio, camp- for not taking care of the building by saying, this is ing trips, dinner trips, movie dates, BarB.Q. dinner your home, why don't you take care of it?"On the dates, swimming parties,intramural sports and cot- otherhand theyallowtheresidentlittle,if any tage open house. freedom as to cottage managem9t. At both No.729 and No. 6A the residents and stall jointly have dec- In helping residents to plan programs, itis hoped orated the building.They have together done handy- that the experience will enhance selfesteem.This man fix-up jobs rather than calling the maintenance has certainly been the case and in many respects the department. Theyhavepainted bothcottages cottages give an outsider the icapresSion .r a frater- completely on the inside.The residents are encour- nityhouse, rather than aninstitutional dormitory. aged to purchase furniture for themselves and for the Although initiallresisted by many traditionbound building. The young men are assisted by the staff in members of the '.rf,itis apparent that the inroads constructively utilizing the physical plant according made at No. 729 and No. 6A have liberalized the to their own needs and desires rather than those of socialexperiences of residents throughoutthein- thc staff.In the yard they have repaired and painted stitution. lawnfurni'-e,purchasedflower seeds and taken total responsibility for the cottage gardening needs. Staff play animportant rolein helping the resi- Due' to the staff trusting the residents it has not only dents use social experiencesin such a way that savedtheinstitutiontimeand money,but more

1 6 around living independently as well as such ithas served to teach the residents ings importantly, tangibles as budgeting, cooking etc.This proved a skillsandresponsibility. This joint partnership tangibly doing together, valuable opportunity for the attendant staff topartic- of residents and staff through Helping has permitted a deepened understandingand respect. ipateinarichly rewarding experience. thesemen toleavetheState Schoolhelped the attendants feel they had a purposeful job. G. Therapy Groups Since the program began 2years ago therc has The use of small groups he.5provcoits worth been considerable mobility as theresidents advance many times in areaswhere both individual and mass and leave the program.During this period, of the techniques have proven useless, original group of 60 young men, 53 haveleft for the community,or have beendischarged. Many new VI. Summary and Conclusions residentshavebeenbroughtintothe programto replenish the ranks.In order to help these make the The intentisto demonstrate that opportunities transition a variety of "therapygroups have been for creative cottage programming arelimitless. With utilized.Some of these groups have been cottage the help of the residents, the cottage can become orientation groups.One group has been set up for social-emotional maturation.With Another group a forceful tool for new residents moving toNo. 6A. theassistance of other staff,the attendants can bridgesthe gap from No. 6A to No.729. The help residents learn many things aboutthemselves, psychologist director has been assisted by the cottage theirbuilding,theirState School and about the in working with these groups.Frequently the attend- world in which they live.The program at No_ 729 antorcottagesupervisor alsoattends sessions. and No. 6A has just gotten underway.Many new Through rather unstructured freefloating sessions, and exciting activities for residents and staffwait. "un- theresidents are offered the opportunity to However, staff must always he on guard to prevent wind." Generally the residents arcencouraged to "Stale, canned programming"dangcrously outof step talk about their new environment,focusing on their with the needs of the residents. feelings, pro and con.Often they find it of value to bring out material in the presenceof others sharing These groups help bridge Many changes have occurred in the past few years. the same experiences. Many of these zihanges have been brought about by a particularlystressful situation and thus speed up Another group waset up several those workingwithincottagesettings.One of their assimilation. is the change from custodial to months prior to placing four young men tolive independ- the most important caseworker was asked to residential treatment.Whether at a half-way house or ently in an apartment. The be the participate in joint meetings betweenthe four men and at a State School the cottage program must nucleus of this change. the director.These meetings focused both onfeel-

-1 7 21 PART Ill

Training Attendants To BeDormitory Teachers Of The Mentally Retarded

Sharryl Hawke, M. A.

Language Specialist Thereisa new flag around which institutional course, was what to do:Considerable analysis. writ- fervor is rallying the popular name is dormitory . ing anddiscussion has dealt -aid, this problem. How- programming. Administratorscallforitsimple- ever, its compa.aion question .r who should do the pro- mentation ; n-servi cetrainingdepartmentsextolI gramming has in'some cases been even more difficult its virtues; supervisory personnel pay lip-service to to solve and certainly less has been written on the it, and attendant staff puzzle at its meaning.Under point. Usually the increased administrative interest in itsbannerfallseveryconceivableactivityfrom dormitory programs was not supported with additional toilettraining totoilet cleaning; wall painting to staff.Unless specific persons were designatmL the finger paintingpplication of restraints to application area of programming didn't clearly belong to anyoneof of cosmetics.Few dormitories would admit to the the regular institutional staff in most instances lack of programming, hut few can point tO anything they already had too many duties. specific and planned enough to be realistically called a'program. By default, the responsibility for programs too often fellentirely on the shoulders of the already under- The interestin dormitory programming in institu- staffed dormitory personnel:in too many cases they tions for the mentally retarded has, however, develop- were poorlyprepared for the tasks if there was ed for good reason.In recent years some institutions preparation at all. Attendants were told to start a have begun to undergo a change in function within grooming program,for example, but were given no society. With the development of more community guidelines for thc goals or direction of the program. diagnosticand treatment centers for the mentally re- Usually no extra money was released for the imple- tarded, institutions have begun to be relieved of the mentation of any programs.As might easily be pre- duty of long-term custodial care for MR's.Instead dicted, dormitory programming suffered numerous un- of being virtually required to provide "warehouses timely deaths and subsequently many resentful emo- for the confinement and concealment of the retarded, tions came to be aroused litthe very mention of the institutions are beginning to find themselves expected word. to be short-term treatment centers,facilities where MR's can be placed for the skill-training and behavior It was during the early period of interest in dormi- shaping which will enable them to return to families tory programming that the Hospital Improvement Proj- andcommunities and therefunction appropriately. ect at Austin State School began its five-year tenure. This shift in function has required not only change in The staff of the grant was assigned dormitories and administrative philosophy but has necessitated a re- their populations for the purpose of intensive reso- vamping of thinking and ''doing" at the grass roots cialization. 'To be rcsocialized. residents would need of institutions.At every level ofinstitutional staff to improve in areas such as social skills, personal the question has become how do we attain the goal grooming, housekeeping tasks and specific occupation- of retraining and return ? Institutions know how to al skills.To accomplish resocialization goals dormi- institutionaliZed and confine the problem is how tory programs would be necessary, since dormitories to deinstitutionalize and return. were to provide the working base for the project .The grant was assigned no additional dormitory personnel lt was during this kind of examination that dormi- So it would work within the limitations of traditional tories were singled out as crucial elements in the new institutional personnel shortages.It was clearly the orientation.Clearly dormitories are key influences in task of the professional staff to design and implement the lives of residents of all levels. For residents who the programs theyfelt necessary to accomplish the attend academic school or work on jobs, dormitory goals of the grant. but it would be impossible for the life still influences the bulk of their day, but for res- professional staff to always maintain programs for all idents not involved in such activities the dormitory the expected population on a day-to-day basis.in- environment crucially and dramatically defines thelim- corporation of attendants into the roles of programmers it of their experience.The realization of the impor- seemed a practical alternative. The questions that had tance of dormitories seemed to be exceededonly by to be answered at this point were: 0) could attendants the realization of their untapped potential.Thus, the play a role in dormitory programs?(2) If so. how much rallying cry became'dormitory programming!' of a part could they realistically be expected to play? and (3) What would need to be done to capitalize on Numerous problems arose from the very inception of the attendant's talents and use them to the best ad- dormitoryprogramming. The principle question, of vantage in dormitory programs.

19-- 23 It did not take long for the HIP staff to agree that on of the HIP grant. Thepopulations served rang- indeed attendants could play a part in dormitory pro- ed from teenage educable, .0 young adultrehabilitatiun distrubcd,retaidedgirls. gramming. Attendants were the most universally candidates,toseverely available people in an institution; institutions cannot The programs.';,..erevaried.Some programs were Generally attendants are more formal classes where specific skills such astelling operate without them- concerned with enduring in their employment than otherinstitutional time or sewing were e:ught: others were employees. Professional staff tend to come and go but the development of se[f-grvernmentin the dormitory: of usually a sizeable core of attendants remainwith an others were programs to provide constructive use With them there is hope for long time for severely disturbed residents,including acade- institution for years. were term continuation of programs.But most important, mic work and arts and crafts projects: sonic attendants are the people within any institutionwho group therapy sessions toimprove interpersonal re- know the residents best. They are incloser proximity lationships and social skIlls.In the development of these varied programs certain principle:.for training to the residents and establishday-to-day relationships have whieh a professional uan never effect byperiodic visit- attendants to be teachers, trainers and therapists have a emerged. The observations which follow arebased on ing.As a result of their contacts, attendants incorporating at- knowledge of the residents and have thetalents in di- the experiences of the HIP staff in !acting students which offer muchpotential for dormi- tendants into dormitory programming. tory programming. Thusthe IHP staff concluded that key Most programs are begun at the initiative of a pro- attendants not only COULD but SHOULD play a fessional staff member. This is reasonable since the role in dormitory programming development. professionalstaffshouldhavegreaterskillsin Determining that attendants would he involved was analyzing and assessing the needs of a dormitory pop- easy enough -= determining howmuch they realistic- elation. As an example, attendants can spot in- ally could be involved was more difficult.The very appropriate behavior but professionals can better ident- practical consideration of time had to be dealt with ify the specifi c behaviors wh ich are amenable tochange ina program of therapeutic social skill training. first.As a rule, attendants are very busy people and they react negatively when asked to take on inore re- When the professional goes to the attendant with the A second reaction is often one of inad- initial suggestion for such a program, thc chances of sponsibility. the idea being embraced are considerably enhanced if equacy.Attendants have not traditionally been ex- sought pected to he teachers or trainers (althoughthis type the opinions of the attendants are genuinely and attended to.This is more than an exercise in of work goes on vontinually on an informalbasis).As Since attendants unqualified to take on a programming patronizingfor the professional. a result, they feel know residents and dormitory situations better than job.Many feel it would be impossible to changefrom often spot an aspect of a teacher-trainer professionals,they can their disciplinarian-eustodian role to a program that is doomed for failure.However, if they role. feelthe professional has already made up his mind intheir opinions they Problems which are actually more difficult to over- andisnotreallyinterested real.' rather than " felt- inad- will pay lip-service to even the most insane idea as a come center on the form of subtle sabotage.This type of problem arose equacies of attendants. Attendants have awide range Austin State School when a professionalstaff of talents, but because of lack of education and orien- at member noticedthe poor clothing selectionsmade tation they generally are not able to designand set up residents in their daily They find it diffieult to concept- by a group of female teenage effective programs. grooming.As a result, she came to theattendants ualize curriculum design or the necessity of written teachthefiner They do not have time nor do they witha proposalfora programto program plans_ coordinating. Theattendants know where to go for materials and ideas toincorporate aspectsoffashion These inadequacies are real, and if passively agreed to a series of classes eventhough into a program. they knew that most of the girls involved hadonly they are not compensated for they lead toconsiderable skills of attend- three or four garments to wear, and thereforewere frustration which inhibits the obvious not really in a position to practicefashion coordinat- ants. ing.Much time and energy was wasted beforereal- isticgoals werefinallyestablished. Thus,any Taking into account the various strengths and weak- dormitoryprogram needstobeginwithanhonest nesses of attendants, a number ofdifferent darmitory exchange of ideas and suggestions betweenattendant programs were implemented inbuildings under the di- and professional. -20 21 point both content and formatof the workout most effectively whenthe professional Atthis guiding program should bediscussed.If the program is to he staff member takes the lead in teaching or training,such as learningto count thebeginning of a program.This is particularly oneofskill programming is new money, what will betaught and how the sessions will true when the entire concept of be scheduled need to bediscussed.A program of tothe dormitorystaff. However,itisimportant student government would need tohave the general that attendants be established as pkrt of the rs-ogram goals outlined and a basic plan ofprocedure deter- from its inception.There were instances of programs during the HIP gritin which a professional person mined. took the entire responsibility for a beginning program for the with no involvment of attendants.Immediately the Based on the agreement to the general plan readiness class, program, it then becomes thetask of the professional class,inone case a vocational It is at this was identified as Mrs.X's class and later when the to put meat on the bonesof the idea. into the point that many programs fail.An idea for a program professionaltriedtowork an attendant will be generally agreed upon, but no onetakes the teaching role there was muchreluctance. The attend- requiring professional responsibilityofgettingthespecificson paper. ant viewed the job as one least skills and therefore felt incompetent to assumethe Since this task is in the area of the attendants' educa- skill,itbehoovestheprofessionaltomake the role.Conversely, in another program of adult specific plans for implementing the program.If it is a tion, attendants were included fromthe beginning as program of skill training,such as learning to cook, part of the teaching panel.At first the professional which requires materials to be gathered ormade, the staffborethemainresponsibilityfordirecting professional should do it or see that they are pro- classes with frequent contributions elicted fromthe is a group therapy program, then the attendants.Over a year's time the attendantsdevel- vided. Ifit and eventually professionalshouldoutlinethe specificgoals of oped into the mainstay of the panel therapy and be able to indicate thegoals and ap- assumed total responsibility for the program.The proach for each session.The crucial factor is that conclusion drawn from -these and other experiences of the proposed program be put down on isthatprofessionals needLo assume theinitial specifics is paper. The original plans may well bechanged, leadership of programs until directisu and content but something concrete is needed as astarting point. firmly established and untilattendants are confident found at the of their abilities.But attendants need to be a part Examples of such written plans can be gradual conclusion of this paper. of the program from the beginning. Through a process,professionals can step into a supportive will assumeleadership with With written proposalinhand, another meeting roleand attendants with attendants should be arranged by theprofession- considerable confidence and sustaining interest. al. Again an atmosphere of honesty and genuine sharing is essential.With the "nitty-gritty" of the Another important but subtle factor which comes program before them,attendants can point out pit- into play at the inception of new programs is the fallsand omissions which will be criticalin the relative importance of the program as perceived by functioning of the program.They can evaluate the thestaff.As a general rule attendants have too appropriatenessof thecontent proposals,the ad- much expected of them, and they must constantly equacyof the dormitory facilityfor handling the set 'priorities for the work they do.Dormitory program- program, and the abilitiesof the residents to meet ming, because of its new and uncertain status, can thestated goals. When basic contentis agreed easily take a back seat to more traditional tasks upon, other detailsof timing, grouping, and imple- suchas building maintenance. The professional menting need to be worked outtogether. At the should make clear, by word and deed, what priority conclusion of such a sassion or sessionsboth the he wants programming to receive.If he believes a professional and the sttendants will have muchtime certainclassor group to be more important that and energy investei= in the program.This kind of mopping the floor the third time during a shift, he 'vestedinterest'.isoften the best assurance of should so state.This statement of priority has then successin pregramming. People are reluctant to to be followed up by his actions.If he walks into a let programs fail or meet with only partial successif dormitory, finds the attendant teaching a class while they have contributed to their creation. thefloor remains unrnopped, he can make or break the program by his response.If he reprimands the attendant for the dirty floor he ean assume that the Actualimplementation programsseemsto 21 class will he ignored in favor of the floor the next for. The only significant differencein attendant if he commends the attendant for attitudes was observed when a new dormitory was day. However, En this holdingclass and ignoresthefloor the attendant opened for emotionally disturbed retard-Aes. willfeel secure in her choice of priorities. The situation where a dormitory program was built from importance attached to the program by theprofessional scratch, the attendants were found to be more amen- is often crucial to its success. abletothe whole idea of programming and more flexibleinmaking continuinginnovations. The After a program is well-established and the attend- conclusion drawn was that attendants who are put ants have assumed responsibility, theprofessional intoa situation without anexisting structure will should continue to review and evaluate the program. more readily incorporate dormitoryprogramming than If evaluative data are to be kept, the professional will attendants who view programs as an addition to should be responsible for keeping it "collected"; if their regular work load.It would seem advantageous attendants do not see data assembled and used they to have dormitory programmingwell pre-planned in feel it is a waste of their time and will discontinue newly organized dormitories so that attendants would their collection. In addition, it has been demonstrated view programs as a part of their job from thebegin- that it takes enduring interest by the professional to ning. assurethatthe program continues and adapts as necessary.Without an occasional pat on the back Conclusion fromtheprofessional,attendantstaffbeginsto devalue programs and they slide down in their list Itis the conclusion of membe s of the HIPstaff of priorities.Generally it only takes an occasional that the fundamental question of whether attendants " look-see" to maintain a program, but this is crucial can be used effectively asteachers and therapists to its vitality. indormitory programshas been answeredinthe affirmative. Not only can attendants be used, but One finalfactor which seems important to the givenproperguidance,theybringmany talents success of all dormitory programmingis the degree to a program situation and canfunction as effectively ofsupport the professional iswilling to give the as many better-educatedprofessionals. attendantsin defending the program tothe admin- questions istration or other concerned people when It is the factor of providing guidance to the attend- arise.This problem often comes to focus if a pro- For example, a ant-trainer that is crucial.The weakest skills of gram has elements of controversy. attendants are in the areas of originating, designing, dating program, where boys and girls areallowed to controversial and implementing.If a professional takes the lead date within certain guidelines, is often in conceiving and getting the specifics of a program in an institutional setting.It can easily happen that to paper with consultation betweenhimself and even a carefullyplanned and agreed upon program on actually the attendants, the building staff will more enthusias- will run into difficulties when the residents tically greet the implementation of a program.Sim- start dating one another. lf,while under adminis- ilarly, the professional needs to take the lead inthe trative fire, the professional throws theresponsibility But once the format the laps of the attendants actual beginning of operation. or blame for problems into is well-established and the attendants arecomfortable he can be certain that attendants willhave no part reinstituting the in their role, they can take increasingresponsibility in defending such programs or in and eventually total responsibility for the program. program later.As a whole, attendants are not ex- After that point the professional aced act only as a ceedingly secure intheir positions, and they will avoid programming rather than riskcriticisms and reviewer and evaluator. controversy.Thus,itis essential that the profes- effortsespe- Underlying the success of any dormitory program sional be supportive of the attendant's is the value which is placed on it by the attendant cially when the chips are down. staff as influenced by the professional staff.If the Observationally,littledifferencewas noticed professional staff considers a dormitory program to be weenthereactions of attendants working with be of importance, then they must demonstrate that differentlevels of population when dormitory pro- value to the attendants by rewarding the attendants grams were begun. The advance preparation and for their participating, even if it means overlooking general procedure for implementation seemed to be the other more traditional functions of attendants which same no matter what residents were being programmed may be less well done as aresult of that participation. 22 26 When theprofessionalstaff demonstratesahigh (6) Care of washer and dryer, regard for programming the attendants willassign it a a. Demonstrate how to clean hoth machines. high priority and the program will be on its way to much success.All will stand to gainthe resident, Notebook Work. the attendant-teacher, and theprofessional. Adult Education Curriculum Housekeeping Training Curriculum "You and the Law" HOUSEHOLD DUTIES DAY 1 SESSION 4 DUTIES OF THE POLICEMAN GOALS FOR THE DAY (Example) (Example) T3 teach correct procedures for preparingand washing clothes. Points for discussion: To teach the use of laundry cleaning materials. To teach the proper use and care of a washerand Purpose of law enforcement officers. A. The main purpose of policemen is to help dryer. people. 1. Police help people who are having trou- LESSON PLAN ble. 2. Police protect people from other people (1) General discussion of what the class will be learning in the household duties class. who would cause them trouble. B. Even when police have to arrest a person, Preparing clothes to be washed. they do itto help that person by keeping (2) him from committing a more serious crime. a.Demonstrate the sorting of clothes into groups according to colors andfabrics. b. Demonstrate how to determine the right EL Duties of a Policeman. size of loads. c.Have the girls practice sorting. A. Policemen have three main duties: 1. Policemenhelppeople whenthey (3) Discussthepurposeofdifferentlaundry need help. cleaning materials and show examples of each. 2. Policemenarrest people who have a. Detergentto clean. broken the law and bring them into b. Bleach = to whiten. custody. c.Conditioner for softness and firmness. 3. Policemen tryto prevent trouble by lookingintosuspicioussituations. B. Policemen need the help of all citizens in (4) Demonstrate how to use the wbt-dier. carrying out their duties. a.Loading. 1. You can help the police by not break- b. Setting dials. ing laws. c. Readjusting the load if'itgets unbal- 2. You can help the police by reporting anced. useful information to them. d. Removing of clothes when cyclesare finished. III. What to do if you are stopped by the police.

A. Policemen often stop people for question- (5) Demonstrate the use of a dryer, ing if they have reason to think that the a. Loading = warn not to put certain kinds people might be in trouble, or might be go- of fabric in the dryer. ing to get into trouble. b. Setting dials. 1. Usually the police will just question c. Length of drying time for different fab- the person where he is. rics. 2. Sometimes if the police are not sat- d. Removing of clothes. isfied with the person's answers, they

23-- will take him to the police station for man, he will automatically suspectthat more questions. you have done something youshould not B. Whenpolicestopyou theywill ask these have done. kinds of questions. 2. Ansiier the polieem's questions 1. What is your name? fru! :ally. 2. Do youhaveanyidentification? 3. What are you doing here? When a policeman stops you, he is trying to find out 4. Where do you live? what you are doing.Just because a policeman stops 5. Do you have any money? you does not mean that he thinks you havedone 6.Do you have a job? anything wrong. So answer his questions truthfully. 7. Where are you going now? If you lie, he will become suspicious of everything you say. C. If you are stopped by the police, there are two things to remember: Conductrole-playing situations. Having students I.Do not run.If you run from the police- respond to policeman's inquiries.

--24 PART IV

Programming for EmotionallyDisturbed, Retarded Children in a BehaviorModification Setting

Sharryl Hawke, M. A. Language Specialist Mosi isstitutions are designed toprovide care and model. Programming was structured so that appro- rehabilitation for a specificpopulation.State hos- priatebehavior earnedrewards; inappropriate be- pitals can adequately serve thementally disturbed havior resulted in lack of rewards or in punishment. deal with deliquency For the first nine months rewards were given in the and ill; state penal institutions From this ground and criminality; state schoolsoffer care and training formof checkmarks on cards. for the mentally retarded.When a person's problem work a more sophisticated reinforcement system was is singular rather thanmultiple, and when that per- begun in September.In the refined program residents son is committed tothe appropriate institution, he wererewardedwith " poker-chiptypetokens. generally received adequate careand treatment. How- Some tokens could be earned for specifically des- taskssuch as housekeeping or grooming. ever,ifthepersonisinstitutionally misplaced ignated through inappropriatr commitment orif the multiple During periods of the day when this typc of task Was makes him inappropriate to any notplanned, tokens were awarded by means of a nature of his problems Appropriate behavior one institution, thenproblems arise.Both the res- buzzer reinforcement schedule. ident and the institution becomefrustrated by the between the approximate 20minute intervalsof the lack of suitable progress and a continuing gameof buzzer earned tokens. "move the resident" (from dormitory todormitory or institution to institution) is played with vigor. The tokens earned by residents wereused for beh the necessities of daily living and forspecial privileges and treats.Residents were required to One such population within schools for the mentally of tokens for each regular retardedis the group of emotionally disturbed, re- pay a specified number schools. meal and for the opportunity to sleep in abed in a tarded who seem always to be found in state If sufficient tokens had A population survey at Austin State Schoolin 1968 regular bedroom at night. revealed that 5% of the total enrollment fell into a not been earned the residentsreceived a mixed plate In this (small amount of blended food) for mealsand slept categoryof "disturbed and disturbing". floor of a less attractive room at category females out-numberedmales by a ratio of on a pad On the night.Also fines were assessed from tokens earned 2 to 1.Thus, preparations were made to begin a When the special unit within the school to house and program for clearly-defined inappropriate behavior. retarded residents carned more than enough tokensduring a for a small group of emotionally disturbed day to pay for bed, meals, and fines,they put the females. remainingtokensintoindividualbanks. These bankedtokenswerethenavailablefor specified Thefacility,calledtheTreatmentUnit, was privileges such as off-building trips andpurchasing opened in January, 1969.The designated I.Q. range material " goodies" from the on-building token store. for residents was 35 to 75.Primary consideration Thus token earning was essential to thedaily life for admitting girls to the unit was that they display of each resident. disturbedordisturbingbehaviorintheir regular dormitory situation.Within a few months thirteen girls between the ages of 13 and 36 came to live in Staffing for the unit consisted of a psychologist, the dormitory. teacher-programmer, attendant coordinator and three assignedattendants pershift (two attendants on From the outset it was recognized by the staff of duty at any one time).It was housed in an older the unit that its purpose was to modify thereeidents dormitory which in addition to semi-privatebedrooms, appropriate and hadadayroom and two classrooms which were so that their behavior.would be more A serioushandicapin acceptablewithin their regular dormitories. The availablefordetivities. for programming was the lack of finances.There was unit was not viewed as a permanent care center for supplies or materials, problem residents.Neither was it seen as a rehabil- very little money available itative dormitory with the goal of returningresidents so programming had tobe done on a shoestring. tolivein the community.Instead, the Treatment Unit was a center to reshape behavior to be accept- In planning the spe dies of the TreatmentUnit considerationsweremade. ableandmanageablebyinstitutionalstandards. program,twoprimary which First, what kind of programming would beeffective This orientation was important to the program the day of was subsequently developed. and realistic in therapeutically occupying a resident.It was clear that every hour of the This unit was set up on an operantconditioning resident's waking day would need to beconsidered 26 30 because total control would be essential in changing madebytheresidentsaboutthewitholding, the behavior. This was not to imply that an activity attendanthas three alternatives based on the guide- wouldorshould be scheduledforevery minute- lines established for behavior management. 1)She Rather it meant that all time should be accounted for can continue to withhold tokens in upcoming reward and observed. Further,programmingshould be situations; 2) She can fine" the resident a specified realistic by standards of normal dormitory program- number of tokens for the specific infraction; 3) if the ming.If residents were placed in a situation drastic- point comes when the resident no longer has tokens to ally different from and superior to the dormitories to pay for repeated fines, or if behavior becomes unman- whichthey would return,thetransition would be ageableby verbal exchange, the resident may be difficult, if not impossible. secluded or restrained using Fre-determined methods. Secondly, programming on the unit would have to bedoneinaccordance withoperant conditioning principles. Programming would work within a con- Thehousekeeping andgrooming activitiesare ditioning framework, thus a reward system needed to essentialto resident's transitions both to and from be established in the original design of the program. the Treatment Unit.Because building maintenance is Programming would be planned to enact the theoret- always a part of a dormitory setting, new residents to ical principles of operant conditioning. the unit adapt most quickly to this aspect of the program. Even more important,itis necessary that the The following discussion describes the result of residents continue to be required and encouraged to the program which was eventually established at the do housekeeping while on the unit since this will be unit. There are basically six differentkinds of an expectation of the dormitory to which she is return- activities that take place within any one day on the ed.Improvement in her willingness or skill in house- unit plus religious activities which are held once a keeping and grooming will provide evidence to her week. The purpose of each of these activities and home dormitory staff that retraining has taken place. how they comply with behavior modification principles will be explored. Academic Activities An aspect of the Treatment Household andGroomingActivities While Unit program which is different from activities of other housekeeping details receive less emphasis in the institutionaldormitoriesisthe academic program. Treatment Unit thanin moat dormitorysituations, Each morning for a period of two or three hours all thereis a certain amount of dormitory maintenance residents in the unit "go to school". The purpose of thatis necessary. At five times during each day thisactivityisnot primarilyto improve academic residents are scheduled to participate in housekeeping skills; the wide age and I. Q. range plus the degree of work. After arising, girls make their beds and tidy distrubance would make that nearly impossible.In- their rooms; before and after each meal, table setting stead, the individual goal for each girl is to improve and dining room clean-up is done; before retiring, a her ability to concentrate on and stay with specified generaldormitory cleaning iscarried out. Along work and the group goal is to teach the residents to be with housekeeping details, girls are also expected to able to sit and work together. groom themselves appropriately. After breakfast a personalinspectionisheld,toinsurethat each The general format of these classes has remained resident is suitably dressed and groomed for the day. fairly constant even though there has been consider- These household tasks are not the central endeavors able change in reinforcement methods and behavioral of ;le staff or residents, but they do provide a con- management since the opening of the unit.Classes sistently followed routine around which other activi- are begun after breakfast clean-up and personal in- ties are planned. spection are complete; they continue until time to prepare for lunch.Glasses are held in a classroom or in For appropriate participation in housekeeping and the dayroom and the girls sit around one or two ta- grooming skills, residents earn a specified number of bles.Classes are taught by the teacher-programmer tokens. For example, if the bed is suitably made, the who is a teacher by training, and one attendant.Stu- attendant rewards the girl with one token.Ifit is dents are allowed to talk freely and move about without not suitably done,the task must be satisfactorily permission, but generally behavioral control is main- completed, but no token is given.In all instances of tained under the same standards as the rest of the ac- tokenwitholding,ifinappropriatecomplaints are tivities of the day. 27 Findingappropriatematerialsforthe academic To secure useful classwork, academically publish- classes has been essential to the effectiveness of ed books and materials have been searched fOr ideas. this aspect of the program. Much experimentation has However in working with very limited finances it has done through the months with materials for this group been found useful to draw upon commercially published and two observations have proved helpful.First, for children's activity books for ideas. These books pro- this heterogeneous group, material which looks alike, vide material which is sometimes more adaptable than but which can be adjusted to individual abilities is the books which are published exclusively for academ- Working with limited staff, there icuse, and they are considerably less expensive. most succeSsful. From such sources many kinds of exercises have been has not been sufficient personnel to hold the three or produced: discrimination,- perception,completion, four classes that would be necessary for homogeneous number use, vocabi 'srybuilding, phonetics, basic grouping, so adapting the material proved and effec- reading,basic arithmetic, money use, time-telling, tivealternative. For example, a well-designed cross- etc.Along with this kind of work, less academically word puzzle can be used with some students toteach oriented but good activity exercises such as color- spelling, while other students can use the same puzzle ing, cutting and pastingprojects are included in a tolearnletter discrimanation.Spatial relationship day's curriculum.During any one day, then, most exercises were used by some girls for their intended students would complete seven to ten items of work purpose; withdrawn girls usedthem only as coloring including, for example, a couple of visual motor ex- pictures. ercises, phonetics or reading activities, numberskills, arid a fun project or two. Such material allows one attendant-teacher to manage the entire group.It is easier to adapt the same From the beginning or th.e class sessions the pro- exercise to skills of each student than it is to have13 gramming specialist and the attendants have worked It has been observed jointly in the classes.Because the specialist was differentexercises to monitor. provided by Federal funding it seemed likely that there inthe group thatthereis much less divisiveness would not always be a professionalavailable for the when all students are working on material which looks academic programming, so a specific effort wasmade alike.Considerable jealousy is build into a closed to train attendants to be able to fill the roleof teach- situation such as. the Treatment Unit and differences er.Initially the specialist was completely responsible in class assignments unnecessarily irritate the always for designing And supplying all materials used in a present problem. clas-s session. However, as the Federally funded staff began to phase out of the unit this responsibility was Secondly, it is essential to provide material which gradually shifted to the attendant-teachers. Sources of length of time.--- 5 to 15 material were discussed with the attendants and the can be completed in a short principles of class planning and material selection minutes.In the beginning of the academic classes the felt could were demonstrated. Ideallythis aspect of progran,,iing the teacher selected The amount of work she Attendantz be completed by most of the students duringthe morn- would always be done by a specialist. each girl. really do not have the time nor do they have the orien- ing, stapled it together and presented it to tation and education to be the most proficient atthis Thismethodcausednumerousproblems because all the task.But because institutional personnel shortages frustration developed when a girl could not get will frequently dictate that the entire responsibility work completed;- other girls finished the material too for programming fall. to the attendants, it iscrucial rapidly to do it correctly, and the teacher actually had that they be given some instruction in thebasics of little control over the pace of the class. To rectify the curriculum planning. situation, the teacher began to distribute the work one page or exercise at a time.When the student completed that page she returned it to the teacher.At this Initially, the specialiat also took the lead in direct- lime the teacher could check the work, requirethat ing the morning rlasses.She set the standards for needed corrections be made, verbally reward the stu- behavior and did most teaching and assisting of student for the completed work and present herwith the dents in their work.However, this function became next assignment.This method has resulted in much more readily shafed betweenspecialist and attendant more positivereinforcement, reduced frustrations and than did the material preparafion because of the ob- allowed the teacher to pace the students in theirwork. Vions talents. of the attendants in working directly To make this system work best, material which isrel- with the students. Once the attendants understood the atively quick to complete has been most effective. goal of each piece of work, they were quite proficient 28 teacher role.Because they had school or have a job, they become bored and frustrated in assuming the With this alreadyestablished leirdisciplinaryrelationshir and do indeed become behavior problems. with the girls, there was less behavioral testing" background the staff projected that One area in which than would have taken place with anoff-dormitory the residents would need to show improvement would teacher, On the other hand, being able to be ateach- be in work skills reliability.If the girls could be- er for a period of eachday also provided a new view trained to be suitable campus workers some of their dormi- of the attendant by the residents aview which tory problems would be resolved. Also, if a campuswork was positive and healthy.So as the months passed the placement could be maintained when the girl returned to attendants became excellent teachers and there was her dormitory, it would serve as a good transitional device. little reluctance by the specialist to leave them in complete control of the classes. While the ultimate goal for selected residents was acampus work placement,thefirst step was to When the Treatment Unit was initially opened, develop some work skills and, more important, work reinforcement was given in the form of checkmarks on reliability on the dormitory. To do this a workshop" cards which could be exchanged for materialrewards. project was begun.The work for the project war, Urrder this system, girls were rewarded in academic imported from other dormitories since residents of the classes with a checkmark as they correctly completed unit were expected to do their own work for token each item of work. There were real problems with re- rewards.Most of the work sent consisted of simple warding the students on the basis of correct comple- clothing maintenance; buttons to be sewed, dresses tion; the most disconcerting problem beingthe wide to be hemmed, rips to be repaired and shoes tobe range of disruptive behavior thatcould be displayed polished.Occasionally special projects were sent, between periods of productive work which was not such as embroidery work or wood sanding. subsequently affected by the checkrnarks. For their participation in workshop projects, the girls are rewarded with money, the most motivating Thus, when the checkmark system was replaced reward of any. The money has been obtained through by the token system the reinforcement orientaticin of fund from which campus working residents are Now class time the the academic classes was ehariged. paid.Instead of paying the students bi-weekly as is iS under the buzzer schedule.At approximately 20 normal for campus workers, the workshop participants minute intervals a buzzer sounds; girls who have be- are paid by the piece for the work theydo.The pre- haved appropriately (i.c. done their work in accord- set prices are minimal, a penny per button ornickel ance with their ability level and avoidedbehaving income for inappropriately) are given a token.If the girl has act- per hem, but this is the only source of ed inappropriately no token is given.Thus, social most residents, so it is quite meaningful. and work behavior is rewarded or not rewarded simul- Workshop is held at a specified time during the taneously.The attendant-teacher has been made re- At that time and only at that time may girls sponsible for giving tokens.This ensures that the day. during class time as volunteer for the work. A few days of experience in same behavioral standards apply letting the girls volunteer, for the work at any time, during the remainder of the day. Along with token re- quickly demonstrated that they would work at the wards, considerably verbal praise is incorporated into For this reason," school money-making project to the exclusion of their other the academic classes. activities. Therefore,the specified time schedule time is probably the most enjoyed part ofresident's was effected, and attendants retaincomplete control and staff's day and certainly is the period of least of the workshop. They teach the girls the necessary behavioral management problems. skills; they monitor the work; they pay the girls, and they take responsibility for seeing that the work is Workshop Activities Most of the residents of the transported to and from the other dormitories. Treatment Unit are beyond academic school age or have been discpalified for school because oftheir Therefore they are,in theory, The workshop project has been an important aspect behavior problems. It has been a stimulus eligiblefor campus work p/acements-In part, the of the total dormitory program. girls who were admitted to the TreatmentUnit were for some girls who are difficult to motivate into doing considered behavior problems because of their in- constructive work.It has provided some "earned" ability to successfully hold a work placement.When spending money.It has taught the girls some useful disturbed, often hyperactive, residents do not go to skills.And it may have helped develop some work 29 33 transferred assessed fines for inappropriate actions.Thus, the rel ability, although this is not as easi/y never became an objectfor manipulation asthestaff had firstthoughtitmight be. The chaplain the workshop by the residents.When the girls earned off-dormitory reliability thatcan be developed in privileges they were allowed to go te thechapel on project on the dormitory is notalways directly ap- participation in the tothecampus work stationwhere much Sundays in addition to continued plicable weekly dormitory service. morepressuretoproduceispresent. Still, the practical way workshop idea has proved an effective, Unit ithirt the dormitory ThereligiousactivityoftheTreatment to encourage constructivework added a vital aspect to the total program.Through program. theskillofthechaplaintheservices remained while Generally within an in- withinthe framework of the token economy ReligiousActivities still allowing the girls some ventfor their concerns stitution, religious activities are conducted bythe regular dormitory staff. purpose. with a person other than the chaplain in a chapel designated for that Because most girls had somereligious exposure in Rarely are religious experiences incorporatedinto a continued their religious dormitory program except for bedfast patients.How- their home life, the services education and development. As aresult, the dormitory ever, in the locked buildingsituation of the Treatment a m aningful andtherapeutic Unit where only one or two girls hadoff-dormitory churchcametobe part of each resident'slife. privileges,it was necessary to " bring in"religious activities. As a result,religion became another ArtsandCraftsActivities The therapeutic aspect of the total dormitory program. qualitiesof arts and crafts activities for retarded anddisturbedpeople havelong been recognized. 'Church," as it was called by the residents, was However,these activities are planned only on an held once a week for one hour in one of thedormitory irregular basis in the Treatment Unit programfor two classrooms.The chaplain of the institution and his reasons.One, there simply has not been adequate assistant were in charge of the services.Occasion- funding to have regularly scheduled projects. The for such supplies allya Catholic priestheld mass for the Catholic unit was not granted specific money Generally, no dormitory staff attended the and materials.Second, in respect to keeping the residents. in line residentsunlessthere was special need. This activities of the Treatment Unit realistically arrangement allowed the girls thefreedom of express- with the activities of other institutionaldormitories, ion that they might not have had withattendants in it did not seem useful to accustomthe girls to elab- the room. orate, expensive crafts.While occupying residents' time with appealing craft projectswould make the Treatment Unit's management problemssimplier,it The chaplain describes the format of the services conditioning forgirls who as being partly worship andpartly group therapy. A was not an appropriate bereturningtolessaffluent dormitories. concertedeffort was made to get all residents to would participate in group singing and the praying of the this aspect of the Beyond these activities the chaplain Therefore,the emphasisin Lord's Prayer. dormitory program has been learning to createfunc- usually presented a story or thought on which further materials. discussion could be based.Frequently these stories tional items from discarded or inexpensive Nearlyeverythingthathas been made could be were biblically centered but had manyimplications practically used by the girls or could be used to for the residents' lives.During such discussions the improve the dormitory.Examples of personal items girls were able to ventilate about numerous subjects coin purses, and a considerable depth of feeling wasdisplayed. that have been made are curler caps, This was the acceptable situation for thegirls to and kleenex holders;dormitory improvements have thechaplain included placemats, vases, and holiday decorations. "let down their hair." However, Arts and crafts projects have also been used as a neverletitturninto a session for mere griping, thoughtful acts either about the institution, families, oreach other. mode for encouraging the girls to do for other people.At Christmas the residents made In accordance with the principles of thetoken eye-glass eases for children it. the infirmary.When illness or death occurred in a staff member'sfamily program,thechaplaintooktheresponsibilityfor schedule. the girls have each created their own greetingcard to awarding tokens on the buzzer reinforcement These have been concrete channels for stim- Thecriteria for earning tokens was"appropriate send. behavior" as determiu.d by the chaplain.Re also ulatingthegirlsto extend themselves to others. 30 re A Duringperiodsofcraftactivitiesthebuzzer building. It should be designed so that residents schedule is in operation. If a resident is appropriately haveadirectentrancefromthedormitory,thus participating in the activity when the buzzer sounds, minimizing the runway problems.Some play equip- she receives a token.As in academic classes and ment and chairs for sitting would be required. With workshop activities, work quality is not emphasized this kind of facility attendants could effectively use as much as work reliability.With these emphases, outdoor physical recreation as a therapeutic activity arts and crafts activities can be a useful partof a when the need arose, rather than always on a prc- dormitoryprogram without becoming unrealistically planned basis. expensive and excessively ostentatious. Leisure Time It would be impossible to schedule Physical Education Activities The Treatment an activity for every minute of the day.There is Unit is a locked dormitory situation. A few residents simply too much regular dormitory work and too many have earned the privilege of leaving the dormitory unplannedeventsarisingthatrequiresome flex- unescorted for specified reasons.Most residents, ibilityin scheduling.Even ifit were possible to however, are confined to the building almost contin- scheduleplannedactivitiesminuteforminute,it uously. Itis,therefore, essentialto have dai ly wouldbe unwise. A common problem ofall the physical education activities.Because of attendant residentsreferredtotheTreatmentUnitisthe staff shortages and the unavailability of a nearby inabilityto use freetime appropriately. Reports recreational area, the physical education department which came from their home dormitories indicated has taken responsibility for arranging the regularly that the girls were usually manageable when they had scheduled physical education activities. something specific to do, but when left without a plannedactivitythey managed tostir up trouble For one hour each day a member of the physical in some way. educationdepartment comes fortheresidents and takesthose who want to go (participationis not Therefore,therearepe_iodsoftime each day mandatory) to a recreational area.ActiviIies have which are purposelyleft unscheduled, so that the included hikes,swimming,trampoline,exercise girls are left to their own resources. There are many equipment, skating, bicycling, and ballgames.During constructiveactivitiesavailabletotheresidents inclementweathertherecreationaltherapisthas during these times; television, puzzles, games, cards, directedexercises and dancing onthe dormitory. paperandpencilsfor letter-writingor drawing crayons,sewing materials,orjustquietsitting. When staffing has allowed, attendants have also There is also a small radio which can be rented for initiatedrecreationalactivitiesfortheresidents. five tokens per half-hour and taken to another room They have participated with residents in dancing and for listening.(This kind of voluntary separationis exercises on the dormitory and have taken girls off encouraged with certain girls as it teaches them the the dormitory for walks and play in the park area. therapeuticqualitiesofbeingalone,particularly Such activities are good for both the morale and the when they are upset with others in the group.).While physical condition of the residents who tend to be these activities are available to all the residents, too sedentary and sluggish for their ages. no one is forced into any activity. The necessityfor physical education with dis- The attendant's role in the leisure time periods is turbed residents is well recognized by the staff of the important. Attendants'firstresponsibilityisto Treatment Unit. The activities that have been carried observe carefully what each girl is doing and whether out have been useful and important to the residents. itis appropriate for that girl.For one extremely However, much more could have been done in this withdrawnchild,just staying awake is considered aspect of programming.Because of staff limitations good use of the time; for another hyperactive girl, and the lack of nearby outdoor recreational facilities, appropriatebehavior requiresthat shebe playing most of the physical education had to be left up to with her toys or in some way entertaining herself. To the physical education personnel.To enable more insure that such observation does take place, leisure attendantflexibilityincarrying out physical ed- time periods are included under the buzzer reinforce- ucationactivities,the Treatment Unit staff would ment schedule. This structures the situationso that strongly recommend the installation of an outdoor, there is positive interaction between attendants and fencedrecreationalareaconnected withtheunit residents at least every twenty minutes.If the girl is behaving suitably she earns a token;if she is produce the desired prosthetic environment. misbehaving or merely sleeping she does not earn for tokens. The behavioral goal ofthe Treatment Unit emotionallydisturbed,retardedfemalesat Austin In addition to the token rewards, attendants add StateSchoolisto modify the resident'sbehavior inuch significanceto the leisure time activities by so that they might return totheir regular dormitories, liberal use of verbal praise for constructive use of behave more appropriately andlead more productive isto time.Too often in regular dormitories residents are lives. The corresponding programming goal quickly reprimandedforinappropriate behavior but provide an environment structured around therapeutic of modi- theirappropriateactivitiesgo unnoticed. Soin activities which will enable the principles addition to the token rewards the girls are verbally fication to effect change. To accomplish thesegoals residents of the unit was praisedforusing timeconstructively. They are an hour-by-hour program for furtherencouraged bytheactualparticipationof developed.Activities include housekeeping, academ- attendants in activities with them.Often the most ic, workshop, religious, arts and crafts,physical ed- -motivating reward for agirl who is constructively ucation, and leisure time periods.Resident behavior working a jigsaw puzzle is to have the attendant join during participation in all these activitiesis rewarded withher intheeffort. This demonstrates to the or withheld rewardaccording to pre-determined stand- residents that the attendant considers this a good use ards. Through the combination of operantconditioning ofher leisure time tonot justal.other "state" technique and therapeutic, constructive programming, game forced on the resident. progress has been made inreshaping the behavior of seriously disturbed residents. Planning for "unplanned" leisure time may be as Unit ina dormitory foremotionally disturbed Based on the experience of the Treatment important for MR'sas any other aspectof programming. The staff the following programming recommendations reality of the dormitory situation to which mostwill persons considering asimilar unit seem justified. should be returnisthattherewill be extensive periods of First, the initial step in planning a program unplanned time.Until a girl can be trained to con- to analyze carefully theresident's behaviors which structively entertain herself she will probably remain areto be modified.Extreme behavioral problems, a management problem. It has been observed that such as aggression, extreme self,nutilation or severe improvement in a girl's use of her leisure time is withdrawal will require considerably different program moderate emotional generallyagood signofoverallimprovement in activities and techniques than only academic behavior. Thus,any program whichexpects to disturbance. For example, arts and crafts or reshape and return residents to regular institutional activities which require theuse of scissorsor the dormitories should provide monitored experience for potentially dangerous items would be out of the ques- the residents in using free time. tion for seriously disturbed students whilethey would bequite therapeuticforthemoderately disturbed. A recognized Conelnsions and Recommendations Similarly, the goal for the behavioral modification method of modifying behavior is to operantly condition planning. arpropriatelyby rewarding must be carefully considered in the program as u bjecttobehave If the residents are potential candidates for discharge suitablebehavior and by withholding reward from To accomplish such mod- from the institution, their program should beconsider- inappropriatebehavior. ably different from that of the residents who seem like- ificationin the practical setting of an institutional dormitory, it is necessary to structure the environment ly to be long-term institutional placements.The em- so that there are opportunitiesfor the residents to phasis for the former would be on de-institutionaliza- displayappropriateconstructivebehavior. Mod- tion with activities directed toward reshaping behavior ification ofdisturbedbehaviorisdifficultinan to meet community expectations. The emphasis for the environment in which appropriate behavior isdefined long-term resident, however, would be on bringing be- mostly as passivity.Therefore, programming broadly havior into compliance with institutional standards. defined here as the planning of daily resident activ- Community and institutional behavioral expectations ityisessentialin a behavior modification model. are not the same. Programming puts the "meat" on the bones of the theoretical principles of modification. Programming From an operational standpoint, a highly structured attendant per- and conditioningtechniquesfunctionjointlyto program needs a person other than the

3 2-- sonnel to take responsibility for programming.Attend- The third recommendation is that a proposed p ant p. function effectively in carrying out programplans, gram needs to be allocated somespecial fund.s for it, but they do not have the time nordo they generally day-to-day operation. Money for dormitory activities is have the orientation and skills to take charge ofplan- usuallydifficulttosqueeze from an institutional ningthe program. Therefore, someone other than budget, but if academic, craft, recreational, and attendants needs to be primarily responsiblefor plan- shop activities are to be effectively and consistently ning the activities, securing the necessarymaterials, carried out, money is necessary.The maintaining of cutting through the inevitable institutionalred-tape, a token economy does itself incurregular expense, overseeing and preferably participating inthe day-to- and the money to keep it operating must be forthcom- day functioning of the program. Ideally,the pro- ing. gramming specialist would be a professionalwith an educational background which lends itself to creative Programming is essential to the success of be- programming.However, if a professional is unavail- havior modification with the emotionally disturbed. able, a supervisory level staff member might bedele- Given clearly defined goals, adequate personnel and gated. The point is that the "buck" for programming sufficient money, a behavior modification program can should stop with someone specifically designated for help institutions for the retarded deal with their small the job rather than be vaguely assigned orfalsely as- but perplexing population of emotionally disturbed, re- sumed. tarded residents.

33 37 PART V

The Treatment Unit: A Total Token Economy For Disturbed Retardates

Robert Conrad, M. A 1. The Problem of Overlap Between Mental illness disturbances which origin..te in a neurosis-like con- and Mental Retardation. flict. Many oti,er patients have super-impoSed emotional problems."(See , !so similar comments by Kaldeck, A. Incidence oEmotional Disturbance Among Re- 1959). Emotional problems also constitute a major tardcs. cause for failures among discharged educable retardates (Stephen, Peck. and Veldman, 1968). It has long been recognized that a significant numberof the mentally retarded also exhibit signs of It seems clear that emotional and behavioral dis- emotionaland behavioraldisturbance (Angus, 1948: turbances constioite a specific and significant prob- Feldman, 1946; Pollock, 1945; O'Connor, 1951; and lem in all levels of retardation.The problem is CorW' Walker, 1950).Many authorities feel that the preval- mon to state schools and state hospitals as well as to ence of emotional disorder is higher among retardates non-residentialfacilitiesfortheretarded. The than normals but some feel there have not been suffic- problem is perhaps most acute with institutionalized ient adequate studies to support this point (Garfield, mildly retarded. 1963). Most studies have surveyed quite specific, non- representative samples.For example, Gorelick (1966) There are considerable problems in the area of di- found that 10% of 886 EMR high school students in Los agnosis of emotional problems of the retarded. Despite Angeles were noted to have emotion-I problems. Meno- the fact that nearly all the major psychotic symptoms lascino (1965) found 31% of 616 referred children (under have been observed in retardates (Sarason and Glad- 8 years old) to a diagnostic clinic as suspected MR's win,1958),the AAMD Diagnostic manual (Heber, "were noted to display emotional problems of a nature 1961)isextremelylimited whenitcomesto the and extent to warrant a formal...diagnosis." Koch (19- medical classification of mental disorders associated 69) found that 11% of 1,049 children seen in the South- with retardation. ern California traveling clinic project had either emotional disturbance or major personality disorder associ- Ifthe mentalretardationispresumedtO have ated with mental retardation. Penrose (1954) found that caused the disturbance you have two classifications 16% of institutionalized retardates showed some type avai lable: t f neurotic or psychotic behavior pattern.The incidence rate in MR institutions is probably an under- Code No. estimate of disturbance in retardates as many of these 83 Psychogenic mental retardation associated individuals are admitted directly to hospitals for the with emotional disturbance. emotionally disturbed. Martin (1969) found that 10% of 84 Mental retardation associated with psychotic the state hospital population in Texas could be class- (or major personality) disorder. ified as retarded. The vast majority of these individuals had never been in an institution for the retarded. I fthe emotional disturbance is not persumed to He points out that the actual figures (which included havecausedtheretardation,orifthe emotional borderline retardates) were lower than many of the problem is associated with some cerebral pathology, hospital superintendents had imagined.The over- oneislimitedto adding a "supplementary term." estimation was probably due to the extreme manage- The AAMD termsfor psychiatricimpairment ment problems that many retardates present.Mercer werelifteddirectlyfromthe American Psychi-tric (1968) points out that "severely retarded patients in Association diagnostic manual (1952): a mental hospital present problems in individual treatment and in ward management far greater than their Code No. actual number suggests." 5X With other psychiatric impairmentbut not further specified. B. Difficulties in Diagnosing Emotional Disturbance 51 Behavioral reaction. among Retardates. 52 Neurotic reaction. Itis particularly difficult to assess the incidence 53 Psychotic reaction. of disturbance of the mildly retarded since such a low pereenzage of mild retardates are ever institutional- With this relatively limited number of alternatives ized.Those who do ,lnter institutions rarely do so you would think that categorizing individuals would because of retardation per se.As Tarjan (1966) puts be relatively simple.The problem lies in the dif- t "On admission most of them manifest behavior ferentiation of "behavior reaction" from "psychotic 35 39 reaction:" particularly in adolescents.In his factor that "all so-and-so needs is a good paddling On analysisof adaptive behavior Nihara (1969)found the other hand, professionals tend to equate most, if thatthe personal maladaptive factors (neurotic and not all, bad behavior with disturbance and thus view psychoticbehaviors)andthesocial maladaptive punishmentasunwarranted,ineffective,orboth. factors(behavioralreactions)foundinpre-adolescents, late-adolescentsandadultretardates were Generally speaking, methods of physical control are mergedtogetherinearly adolescence. Thus, the taboo topics within institutions for the retarded. One institutionalizedadolescenteducableretardateis rarely finds In-Service Training courses on the correct likelytoexhibitadiagnosticallyconfusing corn- use of restriction or restraint.Most institutional pro- binationof psychological disturbances and anti-social, cedures manuals spend more space discussing the con- rebelliousbehavior. Typically, such an individual sequences for disciplinary mistreatment than in out- will be labeled"mildcultural-familialmental lining proper and effective methods.Most behavioral retardation;with asubclassificationof psychotic control techniques are taught informally and are hand- reaction" by a state school while a state hospital ed down from employee to employee.The failure of might diagnose the same individual with the same administrative and professional personnel to contrib- symptoms as behaviorreaction thereby ute meaningfully to the problem of behavioral control absolving themselves of responsibility for treatment. is probably one of the most important causes of mis- If we were to more accurately represent the reality treatment of residents. of the situation we might want to follow the example ofthe latestAmericanPsychiatricAssociation One commonly used technique of control is to trans- diagnosticmanual(1968). Underthenew APA fer problem residents to buildings housing lower level system, whenever a patient has both mental retard- residents.These buildings are frequently referred to ation and a psychiatric disorder at the same time he by residents and staff as "drag buildings.These is given two separate diagnoses (Wilson and Spitzer, buildings often become dumping grounds for bad attend- 1969). ants as well. Given inadequate employees and intoler- able working conditions, the staff must depend on the larger, more intelligent residents to do the bulk of the C. Problems in giving services to the disturbed retardate. work. Altogether too often these working residents are permitted to manage other residents with methods that There are numerous roadblocks to adequate treat- would lead to dismissal if used by an employee. Ad- occasionallyoverlook incidents on mentfordisturbedretardateswithininstitutions. ministrators First, the passive or withdrawn individual is rarely " buildings that would not be tolerated else- recognized by dormitory personnel to be a ' ' problem", whei-e. as disturbance is usually conceived of as behavioral When professionals and attendants do get toget- rather than emotional.Individuals who are behaviorally disturbed may be frequently brought to the atten- her on cases, there still can be a number of barriers tion of the professional staff, usually in the hopes that to impede effective communication. Many attendents the "problem" will be transferred elsewhere.In the feel that only those who have orked a buildinC author's experience, most psychological or psychia- can understand what kindofproblems exist and make tric staffings have been oriented towards differential meaningful suggestions. Another prevalent opinion diagnosis and only rarely have specific behavioral re- is that some problem residents can only be handled commendations been forthcoming.Diagnoses of psy- with techniques that are not formally condoned.A chotic, schizophrenic, or behavior reaction have little common way of impressing these points upon neophyte meaning to the attendant who wants to know what they psychologists and social workers is to turn the prob- can do when a residents attacks them or breaks a win- lem completely over to them and let them make fools dow. of themselves.In other cases, attendants follow exactly suggestions that they think are ineffective with At times endant level personnel fail to under- predictable consequence.An interesting account of stand that "bad" behavior can be indicative of an this kind of interaction between attendants and pro- emotional problem.Certainly within the social milieu fessionals can be found in Scheffe (1964). of the lower and lower-middle class attendant, bad behavior is simply bad, not sick.The cure for badness Often times there is an element of truth in these is punishment.One occasionally hears the remark opinions. Many disturbed residents are exceptional 36 40 It consisted of about half of the management problems Itis obvious that the typical ployee housing. place- second floor of the school warehouse.The unit had custodial ward or dormitory is an inappropriate hail or east wing, had two bed- ment for theseindividuals.They constitute a de- two wings. The shart multiple-handicapped sub-group with special rooms, two offices, twobathrooms, an isolation room fineable, and a restraint room. The long hall or southwing con- needs and problems.Traditional counseling or psy- inad- sisted of 7 bedrooms, the attendant'soffice, 2 class- cho-therapy appri s have shown numerous the dayroom, and 3 bathrooms. ns (Gardner,1967). rooms, the dining room, equacies an3 The bedrooms in the short halldiffered from those in be locked and had The Treatment Unit the long hall in that the doors could II. one-way observationwindows.The short wing was separated from the main hall by a lockeddoor as was A. Background. the main hall from the stairway leadingoutside. Some, hardware cloth During the summer of 1968 it becameknown that a but not all, windows were covered with screens.All areas were repainted to a colorcode large workshop and rehabilitation programwould soon the area. Bed- the Annex Campus of Austin State according to the appropriate activity for beinitiated at rooms were paintedblue; bathrooms, white; class- School.Phase I of the Hospital ImprovementProject and playroom, pink; the of- residents rooms, green; dining room (HIP) had consisted of programming for the yellow. of one male and one female dormitory atthe Annex fices and other off-limits areas, Campus.Since this programming overlappedthe programs and goals of therehabilitation program in many C. Population ways,it was felt thatit would be appropriate to give responsibility for these twobuildings to the in- The population of the unit was limited to trainable coming personnel and seek to meetpressing but un- and educable female retardates who were toilet trained and had all self help skills.En addition, they had met needs. to show some sgns of a positiveprognosis.Their by the Psy- ages ranged from 14 to 37.Their diagnoses were A survey conducted during the summer childhood schizo- chology Department crfthe school had revealed that manyandvaried,ranging from about 5% of the resident populationcould be consid- phreniatopersonality disturbance associated with ered to be seriously emotionallydisturbed.Females epilepsy.Several girls were primarily sociopathic. outnumbered males by about 2 to LIn August, the Over half exhibited violent outbursts of aggression HIP staff submitted a proposal for apilot project for from time to time. One was an elective mute;another for treating disturbed retardates.The administration was largely non-verbal, approved the proposal, designated abuilding and made a small amount of moneyavailable for building renova- D. Daily Programming. tions. A planning committee consistingof representa- tives from the HIP,Psychology, Social Service, Med- 1. Initial Checkmark System ical, P. E. Grant, and Student Lifeand Training de- This committee met a number The behavior shaping program originally instituted partments was formed. considered only tentative of times over the next four monthsand various sub- on the Treatment Unit was committees held numerous additionalmeetings. From at the time.Program changes were made whenever it Inits original form the program these meetings came therecommendations for building seemed necessary. procedures, resemblzd reinforcement programs such as described modifications, admission and discharge fines records, food service, the physicaleducation program, by r.iewitt (1968). There was no extensive use of school and workshop activities and thein-service ortokenwithdrawalforpurposesof punishment. On-site visits were Miron (1966) reported that aversive c,aditioning with training of building personnel. posi- made to a number of local-mental institutions.The the severely retarded compared unfavorably with week before opening, all personnelconnected with the tive reinforcement.Hamblin, et. al. (1969) found that Unit participated in a one-weekworkshop held in co- the introduction of a fines system into a token program operation with the Hospital In-Service TrainingGrant. for highly aggressive pre-school boys resulted inin- cidences of aggressive behavior returning to the pre- program level. The incidencelevel dropped to that of B. Physical Facilities. normal pre-schoolers when the fines weredropped. The building was originally built for use as em- Experience with other token programs at AustinState -37 School had shown that retardates occasionally inter- of these act ivities follows. pret fines as vindictive behavior on the part of the attendant personnelAt times, this interpretation may Household Activities - From the beginning, house- well have been accurate. keeping details received_less emphasis in the Treat- ment Unit than in otherdormitory programs.Oor our- The Treatment Unit program was originally based pose was not primarily to clean t hebuilding Lai to on checkmarks which are marked on cards. There were involve the girls in constructive work. To accomplish three different checkmark cards. Each card was asso- this purpose and to meet basic maintenance require- ciated with particular behaviors and reinforcements. ments, residentswere scheduled toparticipatein As much as possible, the reinforcements were similar housekeeping work five times during a day. After aris- to those associated with the behaviors inreal life.' ing,girls straightenedtheir bedrooms; before and other areas of the school).Figure 1 shows the after each meal certain housekeeping was done; be- " liousekeeping and Grooming Work Carr. Each resi- fore retiring, a general dormitory clean-up was carried dent had one of these cards for each 24 hour period. out.Along with housekeeping details, girls were ex- At the end of each day the number of cheeks were pected to groom themselves appropriately, each ac- totaled and publicly posted on the resident's chart. cording to her ability. For housekeeping and grooming The checks were then exchanged for living and sleep- activities girls were reinforced with checkmarks which ing accomodations for the next. 24 hour period. These they could exchange for a regular bedroom and special checkmarks expired daily and couldn't be savedor furnishings such as curtains, chest-of-drawers. etc. or hoarded. If a resident didn't earn sufficient checks she slept on a mat on thefloor in a relatively an-attractive The "Activity Work Card'' (Figure 2) covered all 44free'' room. academic-type activities aswell as games, puzzles, arts and crafts, and physical education activities.In An elaboration on the household check cords was any IS minute period not more than 5checkmarks could made early in the project.It was felt that the motivat- be earned. Starting an activity earned one mark. Con- ing value of the checks could be enhanced if daily per- tinued effort towards completion gained an additional formancewas publiclydisplayed. Individual bar check as did completion. regardless of the quality. graph charts were made and postedin the hallway. The other two cheekmarks were supposed to have been Each day every girl'stotal (checks earnedminas quality bonus checks and were to be used to shape checks lost) was posted.The wall charts became as progressively higher levels ef performance.The Ac- important to the girls as the check cards themselves tivity Work Cards had no exchange value until all 25 because of the social reinforcement they received from squares were completed.At that time they could he visitors and staff who saw the charts.The graphic spent er saved. display also made it easier for the staff to tell at a glance the general progress of the residents. The third system covered the on-dormitory sheltered workshop.Contracts were obtained with other build- Academic Activities - Academic activities were an ings and departments to do jobs that would have been important aspect of the Treatment Unit program from economically unfeasable to do in one of the other itsbeginning but considerable experimentation and workshops on campus.All work was done on a piece- revision was done in the format of the morning classwork basis and performance was exchangeable for room period.The purpose of this activity was never cash at roughly the same rate of pay as arty other cam- primarilyto improve academic skills. Rather, the pus job. The cost was charged to the department pro- goals were to improve each girl's ability to concen- viding the work.The specific goal of the work-shop trate and work on specific tasks and to teach the res- program was ta prepare residents for placement in the dents to be able to work together in a group situation. campus workshop or other on-campus jobs. Participationinclass work was rewarded with TheUnit beganwitharelatively unstructured checkmarks on "Activity Work Cards''.Girls who frequently changing activity program. Through a trial had campus jobs away from the dormitory also earned and error process in the subsequent months, the staff checks on Activity Cards for doing well in their em- came to agree on a clearly defined daily routine.With- ployment. When a card was filled with checksit in each twenty-four hour period a series of activities could be used to purchase " goodies including items was planned for and observed. A description of each front the checkmark store (such as cosnietics, food and 38 4 for outdoor Over the mon- frequently took the residents to a park urea personal items) or trips to the canteen. dancing and games on important than the exercise or involved the girls in ths the canteen trips became more Participation was reinforced by check- Unlike Housekeeping check cards the dormitory. other reinforcers. marks on the AeLivity cards. which were used up daily, Activitycheck cards could facilitate record-keeping be saved for future use. To Leisure Time - Et would be impossible toschedule and to analyze what each girlvalues, check card pur- of the cards at the an activity for every minuteof the day; it would prob- chases were recorded on the back A This allowed the staff to account ably be unwise to do so even if it werepossible. time of spending. the residents in the Treatment cheeks earned. common problem of all for checks spent as well as Unit wrs the inability to use free timeappropriately. Thus, there were periods of time each daywhich were Workshop Activitie - The purposeofthe workskills and to devel- not scneduled, leaving eachgirl to her own resources. shop was to teach the 6irls useful There were constructive activities available to every- opgood work habits.By arrangement with the Stu- projects from oth- one:Television, puzzles, games, cards, pc:per, pen- dent Life department, selected work cils, crayons, sewing items or just sitting. er dormitories werebrought to the Treatment Unit. Included were shoes to be polished, garmentsto be items to be Whi'ie these alternatives were alwaysavailable, hemmed, repaired or have buttons sewn on, activity.Care- embroidered, and special projectsto be completed, the residents weren't pushed into any ful observation on the use of this time wasnoted. Im- such as wood sanding. provement in leisure time use waSusually a good sign the day when of general progress.For appropriate use of free time Specified times were scheduled during their Activity students could work on the workshopprojects. These girls were to have earned checks on the most rnot- cards.However, it was difficultto establish stand- girls were reinforced with real money - neglect in reward- ivating reward of all.They were paid by the piece at ard s. so there was inconsistency and set prices.Thl money came from theinstituticia's ing this activity. student work fund. This initial checkrnark program, in variousforms of It can be broken Arts and Crafts Activ ties - Artsand crafts activi- modification,lastedfor 39 weeks. ties were scheduled only on anirregular basis. There down into three phases: were two reasons forthis.First, there was neve: adequate money to haveregular projects; secondly, be- Phase 1 (Before the seclus.anroom) cause the girls wouldprobably be returning to even less affluent dormitory situations,itdid not seem It was soon found that adaptive anddeviant be- profitable to have them accustomed toelaborate, ex- haviors were not mutuallyexclusive. Some of the de- the most.s.hecksfor pensive crafts.Nearly aa craft activities were mostdisturbedgirlsearned signed to be functional.Girls made items for them- positive behavior.In an attempt to reduce the fre- selves, such as curler caps and coin pursesor items quency of certaindeviant behaviors, checkmark fines for the dormitory such asplacemats or holiday decor- were introduced aboutthree weeks after the program ations. started. Initially, charges were levied for daytime sleeping (5 checks for 15 minutes), goinginto off- directly disobeying learning to limit (yellow) areas (5 cheeks), and The emphasis in these projects was on an employee(10 checks). work with one's hands and to createuseful items from discarded or inexpensive materials. For their par- Several staff members felt that the absenceof token checks on their ticipation girls were rely rded with fines constituted an intermittanireinforcement sched- Ac tivi ty cards. ule where non-reinforcement wa-imisinterpreted by the behavior was Residents in the residents as meaning that the deviant Physical Education Activities - acceptable.Fines, even when not particularly harsh Treatment Unit engaged in dailyphysical education or aversive,docontaininformationalfeed-back. activities.These physical activities werethought view of the locked dor- to be especially irnportaatin The fines proved to be useful forbehaviors which rrutory situation.The physical education grant staff ignored but not so disruptive as daily for walks, swim- were too serious to be took the girls from the dormitory to call for isolation fromthe group.When it became ming, exercise, bicycling, etc.In addition, attendants 39 4a 4 apparent that the individual token charts were a high- PhaseII(Implementationofstimuluscontrol) ly effective lorm of feedback and source of social reinforcement,it was decided that token fines should From the10th to the 19th week the staff concen- be subtracted from tokens earned before posting on the trated on implementing the check program.With a se- charts.After that it was possible to establish specif- clusion room available, building damage was quick- ic requirements for certain reinfo.-xers.For example, ly reduced to a bare minimum.A restraint bed was access to clothes and trips to the canteen were made constructed for use with those individuals who showed contingent on three or more days with 55 or more little response to seclusion or could not be secluded checks. because of tendencies towards self-mutilation. The use of the restraint bed led to some controversy among Because the goal of the Treatment Unit was therapy professionals not associated with the project.This rather than research, no empirical evaluation of the controversy carne to an abrupt halt when one of the effectiveness of the token fines was undertaken. The girls went on a rampage in front of a number of pro- staff, however, is in general agreement that they have fessionals and administrators and they could see for proved useful as a means of social control. themselves the methods in operation.

There still existed other behaviors which demanded During PhaseIIthere was significantshiftin more serious consequences.These included fighting philos Iphyconcerning aggression. Previously the witlt residents and staff, stealing, running away, prop- staff had assumed that making seclusion or restraint erty destruction, and self-mutilation. a programmed consequence for aggression would lead to a decrease in frequency of aggressive outbursts.It Probably the most immediate and serious of these became apparent that the act of aggression is itself problems was physical aggression.It was hoped that a powerful reinforcement for which negative conse- consistent behaviorally contingent isolation or time quences are a limited deterrant. As much as possible out would prove sufficient to modify or control these the staff shifted to preventing the aggression before more deviant behaviors. Three problems were encount- it happened.Girls frequently gave ample verbal and/ ered: or behavioral warning that they were about to lose control and "go on a rip".If prevention were not 1. We dida't have a seclusion room. Bedrooms leasable, efforts were made to decrease or eliminate on the short hall were lockable but the rooms the reinforcements associated with taking the girl to were not physically strong enough to prevent seclusion.As was practical, the professional staff escape and they contained beds, sinks, and avoided participating or even being seen.Thi; ap- radiators. proach led to a dramatic decrease in major behavioral distrubanees. 2. The professional staff was not particularly adept at the physical manipulation of agitated Phaselll (Cheekmark program) or disturbed residents. The next 1.9 weeks were quite stable. Both subtle Attendants,,,erereluctantto use the tech- and obvious improvements were noted in most of the niques of physical control they had used on residents.A program of aversive shock (after Lovaas other buildings because of the presence of the and Simmons, 1969) was developed and implemented professional staff. for the one serious case of self mutilation. This program proved to be highly effective with no side ef- During Phase I, the professional and attendant staff fects but led to some controversy and was discontinu- became relatively desensitized to each others pres- ed at the request of the superintendent. Air conditior- ence.When this had taken place, the staff was able ers were installed on the building.Towards the end to develop rudimentary techniques for handling aggres- of Phase III the staff began to put less emphasis on sive behavior which were reasonably effective and hu- the check system and thought was given to possible mane. Fines were introduced as a consequence for alternatives or improvements.This led to the estab- misbehavior. After nine weeks one of the bedrooms on lishment of a token reinforcement program during the the short hall was converted and reinforced for use 40th week. as a seclusion room.At that time the population on thebuilding hadincreasedtoatotalof nine. 2. The Token Program 40 44, During the latter part of the project daily activities Token Fines - The bulk of deviant behaviors re- were organized withinthe context of atotaltcken sultedin token fines.These fines led to loss of economy.By that, we meant that nearly all aspects meals, a bare, unfurnished bedroom and restriction to of the environment whis,h were thought to be reinforc- the building.These were four categories of token ing to the individual and that could be broughtunder fines. The lowest category was a 2 point fine.This control were included within the programming (Ay llon was for minor offenses such as being in the office and Azrin, 1968; Lent, 1968). without permission, pestering guests, etc.Five point fineswere assessedforaggressi veacts towards Most positive reiaforcements were dependent on the other residents.Aggression toward staff or destruc- earning of tokens. The specific ways and means tionof property led to a 10 token fine.All tokens these tokens were earned are outlined in Appendix 1. were lost when one ran away or stole someone else's During the dayall t-Lens earned were keptin an tokens Exceptforthelast two offenses, token apronwhichhadeachgirl'sname embroidered fines resulted only in loss of tokens from the aprons. onit. These tokens were usedfortheir meals, The banked tokens remained untouched as anin- fortheir rooms, andforPaying finesfor misbe- centive for future good behavior. havior.Tokens were handed out for a variety of specific as well -as non-specific events. During per- Time Ont Time out from positive reinforcement iods of the day when there were no programmed activ- was used in a variety of different ways.First, for ities, or when the programmed activities varied a great minor offenses that didn't appear to warrant a two dealfr'om day to day, we used what we called the point token fine, the individual missed receiving a buzzer schedule.The buzzer schedule was a fixed token at the next token handout when on the buzzer interval 20 minute timer which set off a buzzer. When schedule.Certain specific behaviors automatically the buzzer rang all those who had been engagedin resultedina time out period in the quiet room in adaptive or neutral activitiesinthe period of time add;.ionto whatever tokenfines were applicable. since thelast buzzer received one token.At the These included fighting, chronic refusal to mind, and end of the day, any tokens left over after paying becoming highly agitated. etc.A resident secluded in a time out area had to remain at least 15 :ninutes roomand board andfineswere depositedin a token hank.Th-se tokens then became available and miss at least one token handout.If a resident for a variety of special privileges such as trips to the appeared to be likely to injure herself or damage the canteen, coffee and visits with professional personnel. building,she was transferred tothe restraint bed The amount of tokens earned in each day (minus fines) orchair. Continued agitate...a,screaming, kicking, were posted on a wall chart similar to the cheekmark and similar behavior frequently was stopped through chart.All those who had 21 tokens or above for three the contingent use of lights out. ormore days were eligibleforcertain additional privileges.Likewise, those with three weeks of good b. Specific Remedial Programs behavior were permitted additionel freedom such as ground passes and the right to attend off dormitory Regular academic classes continued to be held on socialeventslikedances,movies,and parties. the unit for about 2% hours daily. Workshop projects continued to be solicited from The girls were divided into two groups, a high other dormitories and departments.The girls were group and a low group, based on our previous exper- paid cash for their wotk as well as tokens on the buz- ience with them. The high group was differentiated zer schedule. by privileges such as nicer bedrooms and better tables in the dining room, but had to, in turn, pay more for room and board. All housekeeping choree on the building were per- formed by the residents. There were no residents from In addition to formal reinforcements, there were a other dormitories assignet1 to work on the building. wide variety of informal verbal and social reinforcements that occurred spontaneously within the context Whenever possible, outside placements in the work- of the environment. shop, the trainable school, or on-campus jobs were utilized to bridge the gap between the unit and ihe Aversive Consequences home dormitory. 41 When it was felt needed. volunteers and foster grand- going into offices without permission, nothaving to- part% ts provided one personalidOl ionsh ipson a kens to pay fines, verbal power struggles with star( regular basis. etc.Major and minor incidents had an insignificant correlation with each other (requals.01) which shows Personal counseling. usually on an informalbasis, their independence as constructs. wtra provided by bothiprofessional and non-prolession- al staff. Other measures of program effectiveness included mean checks tokens earnedand mean fines.Like se- Lilst,but perhaps more important. considerable elusions. these variables vary considerably in mean- emphasis was put on yonstructive Use or free time. ing from time to time. Free time constitutes the major activity of thetypical dormitory in most institutions for the retarded.Since 1. Major Behavioral Incidenv4 most of these girls had a major partof their difficulty in handling unstructured situations. weprogrammed as Major incidents are probably the most accurate carefully as pessilde the reinforcementof adaptive measure across programs.These incidents could nev- behavior during free time periodsthrough use of the er,be ignored and hence records arc the most com- buzzer schedule, plete. Table 1- 811 Ms the frequency of majorincidents per resident per week for theentire project. The fig- 3. Transfer of Treat fir iiUnit to Special Therapy ures for Phase I 'arespuriously low since there weren't Unit adequate facitIties available.When facilities became available things got much worse (Phase II) andthen During the last few months of the"IP Project dramatically better (Phase HI).During Phase III the the whole institution wasrarganized along a Unit ineident frequency remained stable despite asteady basis.One of these units, Cie Special TherapyUnit, increase in population (see Table 3).Switching Lo was given theresponsibility of progranuning for all the the token program led Lo a better than50wi- reduction disturbed on campus. The leader for thatunit worked in major incidents. with Treatment Unit staff foe a numberof weeks.In the unit was February 1970 the total responsibility for 2. Minor Behavioral Incidents transferred to him. The HIP staff hascontinued to provide eonsultaLion whenever needed.The token pro- The minor incident frequency (Tabl5) is mean- gram has beenmaintained with little or no alteration ingless for Phase I of the eheckinark program.During although a slight increase inpopulation is planned. Phase II, however, there is a definite uphill trend. This is probably due to both an increase inactual fre- III. Results quency as well asdiPerential enforcement of consequences.Phase III shows the same initial dramatic om the beginning attempts weremade to collect drop as seen with major incidents but isfollowed by data that would be suitablefor program analysis. an uphill trend.Again this is probably due, at least Many of the conclusions, however, arebased on sub- in part, to differential enforcement. The token program jective impressions.Freqently important vii-iables is associated with a downhill trendleading to the low- would be noticed only after it was toolate to quantify est frequencies of the whole program. our observations. Building Damage Relatively early in the program we decided that 3. the most frequency of time out periods represented As a cross check to behavioral incidents,the num- significantindication of management :ffectiveness. ber of building repair orders wascollected (Table 6). With increased success, however. time outbecame Excluded from this table are repair orders for things more frequently usedfor behavior thot reprsented such as burnt out light bulbs as well asdamage caus- little or no management problems. For this reasonall Again we see the major or mined by residents of other buildings. time out records were categorized as to same downward trendduring the check program with or according to thedegree of difficulty they presented another significant drop associated with theswitch to the staff.Major incidents included AWOLS, serious tokens. fights between residents, buildingdamage, self mutilation. attacks on employees, etc.Minor incidents included chronic pestering, hitting anotherresident, 4. Cheeks Earned and Lost 42 4 6 Table 7 contains the checkmark data. It was easier to deal with a problem child as a figures for checks earned run high because of '.helib- Whole than it waso work piecemeal on eliminating eralityof the staff clnr:g the initial weeks of the specific symptoms. program.Phase II shows a downhill trend in earnings We had verylittleluckeliminating behaviors and an uphill trend in fines. Phase 111 is caaracteriz- through extinction procedures.We are not sure why. ed by a small but steady increase in earnings but con- A good percent of these Perhaps institutionalized retarded individuals inter- siderable variance in fines. pret no feedback or the absence of aversive consequen- fines represent checks lost for sleeping.During the It could also be test phase, 85 checks were"given" every morning ces as being tolerance or approval. Fines continued to be that we didn't complete Iv eliminate positive reinforce- to all participating residents: ment and that an intermittent reinforcement schedule levied on the same basis as before.Making checks nnn-contingent on adaptive behavior led to the highest was operation. level of fines in the program.After the test was dis- Positive reinforcement of adaptive behavior was continued neither checks earned nor finesregained not incompatable with deviant behavior. We observed their former levels. girls who could emit a wide range of both positive and negative behaviors within the same time period. . Tokens Earnod and Lost For positive reinforcement programs to be most thera- The token program (Table 8) showed considerably (attic,it appears that deviant behavior must he he/d more stability than the check program.Fines remain- at a minimum. ed very low with little variation while earnings crept Aversive consequences such as electric shock slowly but consistently upwards. appeared to he the only successful techniques for certain extreme behaviors such as self mutilation (Bucher Summary The checkmark program was success- and 1.oveas, 1968; Lovaas and Simmons, 1969; I lam i fulin reducing maladaptive behavior and increasing ton end Standahl, 1969). adaptive behavior, but the token programresulted in considerable additional improvements. It is unethical not to treat problems such as self mutilation when known techniques ate available. If of fear of IV. Conclusions and Recommendatns one declines to treat such cases because controversy, onemustfacetheethicalrespon- Itis evident that disturbed behavior among re- sibility for the child's condition. tardatesis t Wet toenvironmental manipulation. Many of the ,echniques developed withlower level A strict program of positive and negative conse- retard- quences produced a happy and relaxeddormitory en- retardates and with non-disturbed higher level had predicted. atescan be adapted foruse withthe disturbed. vironment,contraryto whatsonic Many deviant acts ippeared to be self rewarding. It seems critical that the locus of control, both completely from In other words, simple manipulation of consequences real and perceived, must be shifted didn't always.;1.er the emission rate.In cases such the child to the staff.'Men, control can be returned as this,it was necessary to predict and prevent that to the resident within an operantframework.Before fa- behavior from occurring. That is not to say, however, control can be established, the staff, and physical that the consequences of a behavior such as this did- cilities must be able to handle physically anything and everything the residents are capable ofdoing. n't have secondary reinforcement value. the commueity or Punishment can be good, necessary, ;herapentie. Rehabilitation and returnto if used fairly, consistently, and in combination home dormitory were not realistic goals for a large per- etc., What was needed was a with positive reinforcement.There must he some rat- centage of these residents. prosthetic en,/,ronment (Lindsley, 1964) that enabled ionalfor using punishment other than your ownhos- tility and frustrations (Watson, 1967). the individual to function in as happy and productive a manner as possible.To expect them to continue Most residents got worse before they got better. their good behavior in a typical warehouse type dor- Typically, they woald test all the limits of the envi- mitory would be unrealistic; as unrealistic as to expect ronment to find out whether we were really serious an amputee to walk because;_e has had the use of a about the program and would carry it out as promised. wooden leg for a period of time. 43 4 Housekeeping and Grooming

Work Card

Name7 Date:

Appropriate Night- time Behavior (up to 10 pts.)

6:15 Ge Up

6:30 Dress

7:00 Clean Room

7:30 Breakfast 7:45 Clean Up (Dining Room) 11:15 Clean Up

(Activity Rooms) _ 11: 30 Lunch - - 12: 00 Clean Up (Dining Room) 500 Clean Up (Activity Rooms) 5:30 Dinner

6:00 Clean Up Dining,...--, Room) 6:30 Dorm Meeting

7:00 Clean House (up to 10 pts.)

9:00 Prepare for Bed..-..--...-

FIGURE 1. Housekeeping and Grooming Work Card 44

'148 ACTIVITY

WORK CARD

Name:

Date Issued:

FIGURE 2. Activity Work Card 45 49, 13 1112 a, 10 cr.CD 89 6 to 45 23 1 5 10 15 20 25 30 35 40 45 50 TABLE 3. Population Flow Week .16 .14.12 . 10 . 08 .04.06 5 10 15 20 25 30 35 40 45 50 Week TABLE 4. Major Behavioral Disturbances .26.28 Phase Phase II Phase til I Phase IV .22.24.20 .14.16,1 8 .08.10.12 .02 5 110 15 20 25 35 40 45 50 Week TABLE 5. Minor Behavioral Disturbances 5 4 3 2 1-3 4-7 8-11 12-15 16-19 20-23 24-27 28-31 32-35 36-39 40-43 44-47 48-51 Four eek Period TABLE 6. Building Repair Requests Phase I Phase II 556065 455040 3530 152010 LIMMIMMIN11 5 10 15 20 25 Checkmarks30 Earned 0-- 35 Week Checkrnarks Lost TABLE 7. Checkmarks Earned and Lost 35

5 a" ---

40 41 42 44 45 46 47 49 50 51 52 53

Tokens Earned Week Tokens Lost 111. ------

TABLE 8. Tokens Earned and Lost

5 1 Appendix 1. Token Reinforcement Program

Part I Behaviors to be Rewarded

11-7 Shift

No tokens are to be earned during the night.

5:45 1. Getting up a. 1st call earns (5:45) 2 (maximum of 2) b. 2nd call earns (5:55) 1 c. 3rd call earns (6:05)

6:30 2. Room inspection a. bed not wet or soiled 1 maximum of 4) b. dress self unaided 1 c. Make bed unaided 1 d. pick up room 1

6:45 3 lielphig with breakfast Bringing in the food, (maximum of 1) helping set table, etc. 1 taking out laundry 1

Note: Only the above tokens may be used to purchase breakfast

7:00 BREAKFAST

Breakfast for high group costs 4 toker This group sits 4 to a table, eats on dishes, and is provided with extra ice water and extra coffee (breakfast). Breakfast for low group costs 3 tokens. This group sits at long table and eats on trays. Those without sufficient tokens must miss breakfast. Those on weight program may not have seconds.

7-3 Shift

7:15 1. Take medicinemust be voluntary and without protest; or not haying to take medicine.

7: 30 2. Brush teeth unaided and put well rinsed toothbrush in sterilizing solution. 1

3ining room cleanup (includes taking thiligs back to c.Irt and No. 4).

uitory cleanupdobig regularly assigned task, ;c,ivers trash, halls, bathrooms and day room). 52 56 8:00 5. Personal inspection, (clothes, breath, nails, hair, underarr,:, etc.) (Itaximurn of 2) a, good 2 b. O.K., needs improvement 1 c. unacceptable Note: Those with "unacceptable" rating must clean up but won't receive any tokens.

8:30 6. Off 2.ormitory school or work assignmen ax_mum 11:30 Given upon return to building. 8

8:30 7. On-dormitory classes; buzzer schedule, (maximum of 10:00 5; on average of every 20 mMutes). 4 to 5

10:00 8. Break and free time; buzzer schedule, continued, 11:00 (maximum of 3; on average of every 20 minutes). 2 to 3

11:00 Discontinue buzzer schedule.

11:00 9. Helping with lunch; bring in the food, itelpu-ig set 11:30 tables, etc. Maximum of 1. 1

Note: Any tokens earned up to this point may be used to purchase lunch.

11:30 LUNCH

high group costs 8 tokens. This group sits 4 to a table, eats on dishes, and may have seconds. Lunch for low group costs 6 tokens. This group sits at long table and eats on trays. Mixed plates cost 1 token. They must be eaten away from the table (i.e. hi the corner of the dining room, in the hall, or in the quiet room; depending on the emotional state of the girl involved). The quantity of mixed food should not exceed one normal sized serving. Those on weight program may not have seconds.

11:45 10. Take medicinevoluntarily, without protest; or not having to take medicine. 1

11. Dining room clean up. (includes taking things back to cart and No. 4).

1:15 12. Afternoon activities, (free time, arts and crafts, shift workshop projects, etc.); buzzer schedules, maximum change of 5. 4 to 5

Note: Workshop projects will condnue to be paid i cash in addition to the above tokens.

5 3-- 57 Note: Physical education activities, dormitory workshop services and any other programming Lrivo lying off- dorm people should be reinforced at the same frequency as the buzzer schedule (one per 20 minutes). They should also collect the same fine.

3-11 Shift

Shift 1. Afternoon activities (free time, avts and crafts change workshop projects, etc.); buzzer schedule continued, 5:00 maximum of 6. 4 to 6

5:00 Discontinue buzzer schedule.

Shift 2 Work assignment off building, normally 5 but give change 6 if she comes in too late to help with dinner. 5:00 Given upon return to building. 5 to 6

5:00 3. Helping with supper; bring in the food, helping 5:30 set the table, etc. 1

Note: Only tokens earned before this point can be used to purchase supper.

5:30 SUPPER

Supper for high group cost.; 8 tokens. Supper for low group costs 6 tokens. Otherwise, same rulcs apply as for lunch. Mbt d food costs 1 token, same rules apply.

6:00 4. Dining room, dormitory, and bathroom clean up, (includes everything except bedrooms). (maximum of 2) a. several jobs or one job well done 2 b. Several jobs done poorly (worker attitude) or one job done adequately c. jobs done poarly or done with pushing

6:45 5. Brush teeth unaided and return well rinsed b ush to sterilizing solution. 1 7:00 6. Dorm meeting (or other specific activities such as a walk outdoors, movie, etc.) (maximum of 2) a. attend and parficipate 2 b. attend, no participation 1 c. absent or disruptive 0

7:30 7. Take bath unaided without messing up bathroom or walking nude in hallway. 1 1 8. Rolling hair, polishing shoes, mending, ironing, e e. 6:00 6: 00 J0:00 Work assignment off building. Note: No tokeni, given for anytling after dinner for those with off dorm work assignments. 7

8: 00 10. Take medicine, voluntarily, with no protest, or not having to take medicine. 1

11. Activities, T.V. and free time or to bed early at own request). No tokens given during this period

12. Dormitory room assignment (to free bedroom, regular bedroom or pretty bedroom according to tokens left- over and permanent room assignment),

13. Banking of tokens. (Any tokens remaining after room assignment must be banked and recorded or they will be forfeited.)

14. "Free bedroom will cost however many tokens the resident has left at the end of the day. Part II-Puntshrnents

1. Token Fines

Note: Token fines must be collected for the following behaviors, unless the resident has no tokens in her apron.

A. Inappropriate questionmanipulatory rather than psychotic). 2 Includes: 1. Asking the same question over and over. 2. Asking 2 or more employees the sarne question. 3. Asking professional staff questions thaz should be answered by an attendant. 4. Asking a question when you already know the answer.

2 B. In unauthorized (yello area without permission

C. Changing clothes without permission. 2

D. Hanging over office door. 2 55 59 E. Pestering guests (collected by attendants or stf). 2

Wetting, soiling, vomiting, or selzure5 (real or fake).

G. Stealing (money, cigarettes, etc.). 5

H. Bopping, pinching, striking, or fighting anot resident. 5

1. Sassing or directly disobeying an employee. 5

J. Failure to pay token fine when direc ed.

K. Hitting, fighting, or biting an employee. 10

L. Destroyhig property (windows, dishes, tokens, etc.). 10

M. Going AWOL Loss of all tokens N. Stealing or counterfeiting tokens, in apron as well as in token bank.

Time Out In Quiet Room (or Restraint), plus above fines if applicable AWOL, fighting (resident or employee), including bopping, chronic nagging, chronic refusal to mind, becoming highly upset.

3. Aversive Conditioning

Self mutilation only. Part III-Reward Prices

High Group Low Group Breakfast 4 3 Lunch 8 6 Supper 8 6

Fro_ Apron Babyfood or diet drink Pretty Bedroom 8 Regular Bedroom 5 Free Bedroom 0-4 56 6 0 Trip to canteen 10 Writing a letter (for paper, etc.) 2 Cup of coffee 2 Talking to social worker 5 Talking to priest or minister (other than at services) 2 Talking to psychologist 2 Going off building with volunteer 5 Going off building with foster From Bank grandparent 5 Party, slide show or moving on building 5 Off dorm trips or events 10 Use of canteen book 1 token per 10

Church off building 10 Dances and movies off building 10 Borrowing portable radio 5 Borrowing record player 5 Trip home or furlough 20 Watching T.V. after bedtime (with per mission) 5 Nighttime snack or treat 2

Part IV-Rules

All tokens must be given at the time that they are earned. Don't get behind!

2. The dormitory residents will be divided into two groups: A "high' group and a "low" group. Don't give tokens to the group that you are not responsible for unless the other attendant is unable to be physically present and has turned her apron over to you.

Make sure that-all girls understand exactly why they aror aren't) receiving a token.

4. Eating meals is not required, but voluntary absence from a meal costs the same number of tokens as the meal itself. No charge is made for meals completely missed for bad behavior or sleephig.

Tokens may be kept only in th .,'! aprons or the token bank. All loose tokens found on the building should be confiscated.

6. Loss or destruction of tokens does not entitle a girl to replace tokens. 57 ni unless you actually observed the incident and are positive that the loser was innocent.

7. No one can earn tokens while in the quiet room. They may, however, purchase mixed plates while in the quiet room.

8. You are permitted some leeway in standards for the lower level girls but never help them do something you know that they can do unless they understand that it means not earning tokens.

9. Anyone :aught stealing tokens must be put in the quiet room, must lose all the tokens in her apron, and (if this is a second offense must forfeit all tokens in her bank.

10. The order of the activities listed may be shifted ar und when necessary so long as they all are actually done.

11. Never give tokens for an activity that is not actually done.

12. Girls going on furlough bank all the tokens in their aprons and start over again when returning.

13. Do not make any changes or exceptions to this program until you have cleared the changes with the supervisor.

14. Keep all tokens the office under lock at all times.

15. Special tasks and errands are considered privileges not events to be reinforced.

16.Girls sent to the quiet room must miss at least one token handout.

17.Weekend schedules are the same as weekdays. The buzzer schecl.ile is kept on for all activities including T.V., records, dancing, etc. Reinforcement is given for any appropriate behavior exhibited before and during the buzzer.

18.Anyone may go to the quiet room or Lrito restraints at any time they request so long as they are willing to take the natural consequences.

19./Viyone who sleeps overnight in the shorthall must mop the room they used and the short hall the following morning.

20.Anyone who wets or soils must clean up and mop the area themselves before they can return to normal activities.

21.Tokens in the aprons are to be used only for food, rooms and fines. Left over tokens are banked. Bank tokens are used only for purchasing the rewards or privileges listed in Part II. They cannot be used to pay fines except for AWOL, token stealing or tokencounterfeiting).

22.If any girl misses more than one meal in a day, you must report it to both the physickn and the psychologist. 58 2 BIBLIOGRAPHY

American Psychiatric Association. Diagnostic and Statistical Manual: Mental Disorders. Washington, D. C.: A.P.A., 1952.

1Vmerican Psychiatric Assodadon. Diagnostic and Statistical Manual of Mental Disorders. Washington, D. C.: A.P.A., 1968.

Angus, L. R.,Schizophrenia and Schizoid Conditions in Students in a Speciai School, American Journal of Mental Deficiency,1948, 53, 227-238.

Ayllon, T., and Azrin, N. FL, The Token Economy: A Motivatint; Environment for Therapy and Rehabilitation, New York: Appleton-Century-Cv.)fts, 1968.

Bucher, B., and Lovaas, O. I.,Use of Aversive Stimulation in Behavior Modification, In M. R. Jones (ed.), Miami Symposium On the Predktion of Behavior: Aversive Stimukation. Coral Gables: University of Miami Press, 1968, 77-145.

Feldman, F.,Psychoneuroses in the Mentally Retardel, American Journal of Mental Deficiency, 1946, 51, 247-254.

Garfield, S. L., Abnormal Behavior in Mental Deficiency, In N. R. Ellis (ed.) Handbook of Mental Deficiency: Psychological Theory and Research, New York: McGraw- Hill, 1963, 574-601.

Gardner, W. I.,What Should Be the Psr-hologist's Role?,Mental Re ardation, 1967, 5, 29-31.

Gorelick, Molly C.,An Assessment of Vocational Realism of High School and Post- High School Educable Mentally Rtlarded Adolescents, Los Angeles: Exceptional Children's Foundation, 1966. Hamblin, R. L., Buckholdt, D., Bushell, D., Ellis, D., and Ferdtor, D.,Changing the Game From "Get the Teacher" to "Learn," Trans-Action, 1969, 6(3), 21:01.

Hamilton, John, and Standahl, Jon.,Suppression of Stereotyped Screaming Behavior in a Profoundly Retarded Institutionalized Female,Journal of Experimental Child Psycholo 1969, 7(1), 114-121.

Heber, R., A Manual on Terminology and Classification in Mental Retardation (2nd ed.). American Journal of Mental Deficiency, 1961, (Monograph Supplement ).

Hewett, Frank M.,The Emotionally Disturbed Child in the Classroom,Boston: Allyn and Bacon, Inc., 1968.

Kaldeck, R.,Psychiatric Approach to Mental Deficiency, American Journal of Mental Deficiency, 1959, 64, 50-56.

Koch, R., et.al., The Child Development Traveling Mnic Project in Southern California, Mental Retardation, 1969, 7(2), 46-52. Lent, J. R.,Mimosa Cottage: Experiment in Hope,Psychology Today, 1968, 2(1), 51-58. 59 BIBLIOGRAPHY (continued)

Lindsley, O. R.,Direct Measurement and Prothesis of Retarded Behavior, Journal of Education, 1964, 147, 62-81.

Lovaas, O. 1, and Simmons, Jmes Q., Manipulation oflf-Destruction in Three Re- tarded Children, Journal of Applied Behavior Analysis, 1969, 2, 143-157.

Martin, C. H.,Mentally Retarded Residents in Our State Mental Hospitals, Texas Department of Mental Health and Mental Retardation, 1969.

Menolascino, F. J., Emotional Disturbance and Mental Reta American Journal of Mental Deficiency, 1965, 70, 248-256.

Mercer, Ku zaret,Why Mentally Retarded Persons Come to a Mental Hospital, Mental Retardation, June 1968, 8-10.

MLron, N.,Behavior Shaping and Group Nursing With Severely Retarded Patients, In J. Fisher and R.E.Harris (eds.), Reinforcement Theory in Psychological Treatment- A Symposium, California Mental Health Research Monograph No. 8, 1966.

Nihara, K.,Factorial Dimension of Adaptive Behavior in Mentally Retarded Children and Adolescents, American Journal of Mental Retardation, 1969, 74, 130-141.

O'Connor, N.,Neuroticism and Emotional Instability in High-Grade Male Defectives. J. Neural. Neurosug. Psychiat., 1951, 14, 226-230.

Penrose, L. S.,The Biology of Mental Defect,(Rev. ed.), London: Sidgwick and Jackson, 1954.

Pollock, H. M. Mental Diseases Among Mental Defec ives,American journal of M- ntal Deficgency, 1945, 49, 477-480.

Sarason,S. B., and Gladwin, T.,Psychological and Cultural Problems in Mental Subnormality: A review of research, Genet. Psvchol. Monogr., 1958, 57, 3-289.

Scheff, T. J.Control over Policy by Attendants in a Mental Hospital, Journal of Health and Human Behavior, 1964, 93105.

Stephens, W. B., and Peck, J. R., and Beldman, D. J., Personality and Success Profiles Characteristics of Young Adult Male Retardates,American Journal of Mental Deficiency, 1968, 73, 405-413. Taijan, G,The Role of Residential CarePast, Present, and Future,Mental Re- tardation, 1966, 4(6), 4-8.

Walker, Gale H.,Social and Emotional Problems of the Men ally Retarded Child, American Journal of Mental Deficiency, 1950, 55, 132-138. - 0

rs A BIBLIOGRAPHY (continued)

Watson, L. S., Jr., ApCication of Operant Conditioning Techniques to Institutionalized Severely and Profoundly Retarded Children, Mental Retardation Abstracts, 1967, 4(1), 148.

Wilson, Paul T., and Spitze , Robert L., A Comparison of Three Current Classification Systems for Mental Retardation, American Journal of Mental Deficiency, 1969, 74, 428-435.

61 PART VI

Post Oak Village Campus Half-Way Houses

Oliver E. Graebner, Ed. D. Co-Director, HIP Project When the HIP Grant came to Austin State School campus to prretice the new freed m. Slowly, rules in the summer of 1965 under the superintendency of about segregated activities began to give way to a Dr. Philip Roos, a wind of change was beginning to more relaxed yetprudent programming for contacts sweep over thatinstitution. The new IIIP Project betweenboys and girls. Attendants were called purposed to develop a program of de-institutionaliza- upon for their suggestions and their planning ideas tion for educable retarded young residents who seemed for the management of behavior problems as well as to have the potential for community living.Simultan- for positive work and recreation programming in their eously, other programs were at work changing the in- respective dormitories.There were many struggles; stitution front a custodial to a training and treatment there was much resistance; and at times there was orientation . Paraphrasing an old saw: "You can confusion. But graduaily many changes have been take the child ont of the institution, but you can't take made.None were won without administration support the institution out of the child."Yet this was the andclosecooperationand attendantinvolvement. objectiveof theI-HP project,to de-institutienalize The best and most notable progress occurred where the child.A program was initiated to make them less staff and residents worked jointly, m4th some degree conspicuous. They were taught appropriate dress, gait, of equality, regarding ideas and programs. speech and general behavior. At the seven dormitories assigned under the project patterning of acceptable Now, four years after the start of the HIP project behaviorwas programmed,involving approximately andunderMr. BillDoggett,Superintendent,the 200 residents. struggle between the new look andtheold ways, (the custodial versus training and treatment) is still The staff became oriented to the usual expectancies going on; but a healthy new look is emerging.Two and conduct of residents and notedtheeffects of hundredyoung peoplehave been discharged from institutionalization: depressed affect, lowered HIP buildings with less than 2 per cent returned to the self-esteem,and limitedaccomplishment.It was institutiop because of failure.Some were discharged then determined to!atild poise and self-confidence totheirfamilies;otherstosemi-independentlife among residents by ego-building attitudes from staff. inthe community under the benevolent eye of one They would treat the residents with respect ,consid- or another agency staff member; others discharged eration and confidence.The young people were en- bythemselvestoafull-timejob and independent couraged to exereis-: choice-making in areas at once Living; a few have gone to the military; and others to reasonably safe and secure for themselves and others. training programs in various communities. They were supported in learning to behave appropriately with reference to time and place and to the condi- The HIP staff has long been aware of a number of tion or situation. emotionally disturbed young people who were included among the residents, both within and outside the HIP Oihca needed to be aroused from institutional population.Some boys and girls were more disturbed lethargy, the dulling effects of long-term residence Some weresodisturbed,despitemedication,that inarestr;ctedand rstricting residential center. theycould notfunctionin agroupof ordinarily First the HIP staff,then the residents questioned the retarded young people who were in training programs. established routines for everyday life.After re-for- Local mental hospitalfacilities declined to admit mulation,thenewpatternswerediscussed with these residents except for short periods of seclusion, appropriate persons from the superintendent to the and then usually to be returned to the State School business manager, to head cook, to cottage life super- after only a week or two.With the inauguration of the visors, to recreation therapists, to the chaplain.All geographic uait system at the Austin State Hospital routines were questioned and a few changes were during the summer of 1968 all former retarded res- gradually instituted.The role of attendants began identsfrom Austin State School were returned to to change on the HIP buildings from that of watchers that institution.In this emergency situation the HIP and keepers of children to teachers, counselor& raid staff proposed the establishment of a unit for the helpers of young people who were regarded as tem- treatmentof emotionally disturbed girlsat Austin porarily out of the main stream of life but with the StateSchool. Withthefullcoordinationof the potential LO return to community living.In any eveet, medical department, who continue to supervise the they were worthy of humane and equitable treatment. chemotherapyprogram,a program was inaugurated utilizing behavior shaping techniques based upon the Opportunitieswereprovided,bothonandoff reinforcement model to a group of emotionally dis- 63 turbed girls. opportunity to move out of the ben;gn hut restricting milieu of a well-run dormitory setting into semi-in- Searching on campus for a living unit where such dependent living in small apartments.They are sur- a treatment unit might be established, tile focusfell rounded by a selected group of fairly stable and self- upon one of the HIP buildings where 38 older "girls" supporting girls,living on the edge of the campus. were living.Closure was established by and within near a shopping center whose access isreadily avail- the HIP team for two ideas. The first was tc transfer ablethrough anear-by gateway. Living under a the 38 girls off of their building to other facilities distantsupervisionofactivities,they(unction and thus make room for the treatment unit program largelyontheirownintheordinaryday-to-day fortheemotionally disturbedgirls. The second iif:.-within their own units.They are free to dec- idea occurred when three apartment units located on orateand add comforts to their living unit as they the State School grounds, but separated from residen- choose.There is a greater sense of privacy.They tialdormitories became available. Constructed in hopefully grow in self-concept and in self-worth through 1949tohoase employees,thesesmall, one-story the development of responsibility and trust. apartment units were beinp phased out of their former use.Under the close support and cooperation of the Criteria For the selection or residents superintendent as well as the business manager of Since the focii: of the Village program is to help Aust.inStateSc!....00l,both programs,the treatment unit and the apartments for working girls, evolved each woman functiou as independently as possible simultaneously.These have proven to be the best within her own capabilities and thereby grow in per- double spin-off of the HIP project to date. sonal and social effectiveness, criteria for choosing women are as follows: The Treatment Unitis now operative 54v:re Jan- uary,1969, for 10 to 15 severely emotionally dis- Age, emotional maturity, stabiiii., employability, turbed girls, 13 to 18 years of age. Post Oak Village, and the -bility to function with a minimum of super- a group of 20 small one-story frame apartmentdwel- vision.Residents were chosen who have demonstrat- lings, housing 2 to 3 persons each, is being developed ed the ability to hold employment and to function with for stable working female residents.To date, 12 a minimum of supervision, both on andoff campus. women, 18 to 50 years of age. occupy five units. The objective of the Village program is to sCmulate independentlife and action,thereby promoting their Rationale of the Village growth into a more mature and wholesome adulthood. There is also held tbe possibility to move them en- The establishment of Post Oak Village in largu tirely away from the campus into community living. partfollowstherationaleofthe "Normalization Prin iple'' of Bengt Nirje: It is easily recognized that in a residential center for mental retardates, wz,men, in general, require great- 'My entire approach to the management of the er protection and guidance so as not tobe disadvantag- retaided,and deviant persons generally,is based ed by the predatory elements of society or te fall vic- upon the *normalization'principle." This principle tim of their own social-sexual impulses. The first ten refers to a cluster of ideas, methods and experiences women selected for Post Oak Village were30 to 50 expressed in practical work for the mentally retarded years of age, who had good behavior andwork records in the Scandinavian countries, as well as in some and who would be dependable and trustworthy.They other parts of the world .. . Asexpressed by N.E. would provide a fairly safe corps to begin with.Sev- Bank-Mikkelsen of Denmark, this principle is given eral had been restricted by long-term institutionaliza- in the formula, "to let the mentally retarded obtain tion.Though they hold off-campus jobs, they would an existence as close tothe normal as possible. probably always be in need of a home within the pro- Thus, as I see it, the normalization principle means tective setting of an institution.Others were less in- making availabletothe mentally retarded person, stitutionalizedbut had not had the opportunity to patterns and conditions of everydaylife which are as move out of the usual dormitory life.These, it is hop- close as possible to the norms and patterns of the ed, will over a period of 6 to 24 months grow in per- mainstream of society. sonal and social control skills so that they might eventually relocate into an independent life and work Young wo en at Post Oak Village are given an setting in the Austin or other city locations, and be

64 discharged from the institution. Lion they have invested considerable time, energy. and money in making each apartment home-like and attrac- Pos Oak Village Opens, December 1968 tive hy painting dressers and ether items ori f.irnwire, and hanging their own curtains or draperies. After ten girls had been selected by the IIIP team, they met with one of the HiP supervisors. Mrs. Krenek; Open House the social worker, Mrs. Caro lle Bell; the community work specialist, Miss Mary Jo Weiland; and the project On January 20, 1969. the women of Post Oak Vill- director, Dr. Graebner: in a series of sessions regard- age held the first Open House ,to which staff from all ing life at Post Oak Village. There is continual guid- levels and programs were invited so that they might ance from mernf-iers of tire HIP team. Aclose working see what had been accomplished.The results were relationship is also maintained wi,h the Vocational positive and rewarding to the girl. Rehabilitation counselors, who continue to care for employment placement. Family Contacts

Cou se Work By their attitudes, families can either assist in furthering the growth of residents and the success of Women moving to the apartments have all taken apartment living, or hinder such movement. Therefore courses prepared and taught by the HIPLanguage an interpretive letter is written to each family of a Specialist, Mrs. Sharryl Hawke, which were focused woman moving into an apartment.This is fol lowed, on preparation for community life, coveringsuch areas where feasible, with a home visit.Again, where fea- as hygiene and personal grooming,socialization, com- sible, planning is in process with the family regarding munication with employers and employees, eating out, eventual moving out of the apartment into their re- shopping,using ,1 laundromat, and the telephone. spective home community.Exploration of other community resourcesit.,undertaken by the social wGrker Group meetings were conducted by attendant staff while making home visits. and the social workertodiscuss rules for apartment living. These group sessions provide Summary and Conclusion: opportunity for the women to discuss problems and feelings arising from their more independent s',yle of Austin State School was ready for innovations. The of living and to develop more effective communication climate was ripe to consider new ventures within the skills.Shortly before thefirst group moved into the regular fran ework of its corporate life.The admini- apartments, discussions covered safety rulesregard- stration was alert and sensitive to the needs of resi- ing smoking, the use of gas heaters and appliances. dents first Lnd foremost and had in essence adopted They attended a regular session conducted by the In- the'normalization principle." Semice Training Department regarding fire prevention and a demonstration in the use of fire extinguishers. The staff of the Hospital Improvement Program (HIP) This was the first time residents had ever attended a was sufficiently established and in touch with the training session as invited participants. needs of residents and the pragmatics of institutional life to make its way in new programming. The admini- ApartmenL Facilities stration cooperated and supported to extend the bound- aries "f che HIP operation as doors were opened. The The apartments are composed of one or two-room time was ripe for the introduction of a treatment unit units, with separate bath and shower, but nocooking for disturbed girls, and for semi-independent, on-cam- facilities.Villagedwellers join-the girls living at pus living units for working girls. Azalea and Begonia (rehabilitation dormitories alsoin the HIP project) for noon and evening ineais, but may After five months of operation, Post Oak Village is prepare breakfast at their own apartments,where they a well-run unit within the general rehabilitation prog- have small appliances, coffeemaker, toaster, electric ram at Austin State School. Located on the campusof irons. a multi-disciplinary and multi-faceted general institution for all levels of mentally retarded, Post Oak Vill- In order to encourage personal involvement, each age offers,at this writing, semi-independent living girl purchases her own linens and bedding. In addi- for 13 women, ages 18 to 50.Since the inception of 65 69 the program, Iwomen have been moved in to the prog- two apdItiiietit. whirh vill be paid for entirely bygirls ram, one failed and had to be removed to another unit, living there.These are notticd-in with the institu- 3 have moved from apartments to off-campus work and tional switchboard but operate independently as any living situations, one moved to a half-ti.ay house in other normar telephone in a home. another city.Beginning with three apartments, there are now five in use.As other units are vacated by whilethestaff listenstothe small day-to-day their occupants (employees), they become part of questions and problems of the girls, no serious inci- Post Oak Village and receive more working girls.In dent has taken place since the beginning of Post Oak time. the 20 apartments will be occupied bY working Village.There have bee-1 no instances of invasion gi7is. a total of 15 to 50. by male residents nor running away of the apartment dwellers. The campus hataken Post Oak Village in The latest sign of independence occurred when per- stride, with minimal fears of pregnancies or other un- mission was received to have telephones installed in scheduled activities. PART VII

Out-Reath to FamilMs, A Problem So avinl Process

Mary Jo Weiland, ACSW

and Carob Bell,Aaw Out-reach is a new word for an old procedure in 1965. Its express purpose was to "cope with the social work; that of the soe;al worker going into the growing segment of institutionalized, mildly retarded home of the client to discu problems presented by with socially inept behavior:.There have been 3 theclient and to work with him in an attempt to phases of the program.PhaseI was socialization solve them.In institutions, use of a social worker programs for 62 boys and girls, ages 13 to16, who for home visits has several different functions, all had behavior problems, but also had pre-vocational of which lead to problem solving.One function is to potential. Phase was that of individual social- gather information concerning the resident and the ization,educational programsfor 100 vocationally family situation.Secondly, and of major importance, rehabilitationcandidates. Phase[IIwas social- isthe goal of opening lines of communication be- ization and re-motivation program for 2 dormitories tween institution and family in order that energies for 60 male and female residents each, ages 25 to of both can be focused upon the treatment of the 50 years.This then was the population served oy familymember intheinstitution. Much depends the Community Work Specialist who worked by refer- upon the opening of sound lines of communication; ralsfromthestaff,worsing withtheindividual mutual distortions of family and institution can be resident.The staff of the project consisted of the clarified,disiortionsbetweenthefamilyand the Co-Director,whoisaPsychologist,a Research institutionalizedrelativecanbedealtwith and Psychologist, a Teacher, a Social GroupWorker, a hopefully,the competition between the family and SocialWorker, and3 Coordinating Supervisors. All institution can be resolved through free and mean- information regarding home visits was freely shared ingful communication. with the staff of the project, both by means of written records and direct discussion. The major number Inalltypesofinstitu ions where people are of home visits weremadeinthe company of the placed without freedom of choice, a form of com- caseworker from the Social Service Department who petition appears.The family may or may not wish to was assigned to theHIP project, have the relative at home, but they do usually wish to be first in his affection and to beconsidered the The majority of the home visits were conducted authority of what is best for the relative.On the inthe San Antonio aad Houston areas, although a other hand, theinstitution so frequently views the few families lived inrural areas.With the exception family as a disrupter of institutional routine and as a a small number of families from uppermiddle class nevitive influence upon the resident.The institu- backgrounds, the families of the HIP residents were tionfeels they know what is best for the resident predominantly front minority groups, living in slum and often question why the fainily could not have areas, where the rates of delinquency,illiteracy and handledtheresident's problems more adequately. health problems were very high. Many of the families Staff members may frequently failto understand the were severely disorganized and could beclassified lackof resourcesofthefamily,both emotional as hard-core problem families. Manyof our residents and material, and may, therefore, be unduly critical, had long standing records of delinquent behavior or particularly when the family is reluctant to have the severe emotional problems.The families themselves resident at home or in a half-way house. The family, were poorly equipped educationallyand intellectually on the other hand, may fail to understand the potential to know how to make contact with the institution. of the resident or feel more comfortable if the resident Many had children placed in the institution against continuesinahelplessand dependent position. their wishes when ;avenile authorities and the wel- Thefamily mayfeeltheinstitutionthereforeis faredepartment would intervenein delinquent be- shirkingits responsibilityin wishing to place the havior. resident on furlough or in a half-way house, particularly when it has been so difficult to arrange institu- Becauseofthesecircumstances and previous tionalization in the first place. disintereston thepartof theinstitution, special concernwas giventofeelings and rightsof the It was with some recognitisn of the need to bring families.An attempt was made to view the retarded institutionand familytogetherina constructive family member as a part of a total family situation; relationship that the HIP project at the Austin State therefore, concern and interest was shown about ail School hired a social worker with a title of Community thefamilyworries and problems. Geo srallythe Wo.ic Specialist in 1966.The HIP program was a 5 families responded in a positive way to the visits year Federal grant which began operation inSeptember and many were impressed by the fats of the social 68 72 workers traveling a long distance to see them.The feelingstoward thefamily,theycould then help effort involved in making the home visitheld much Marydealwithhernegativefeelingstoward the the step- positive meaning to families. step-mother. Since theintAitution staff, mother and Mary all began to have more positive The following cases illustrate the use of outreach feelings toward each other, communication of course ot home visits to modifysituations or attitudes: improved and Mary and the step-mother for the first time now have an affectionate, more open relation- Clarification of basic facts concerning he institu- ship. Mary isstill not ready to move out of the tional program frequently brought about rune positive institution, but when mutual distortions on the part between institution and famil., and gave of all concerned were clarified, the institution and feelings unifiedtreatment each a more realistic picture of the other, familycould becomepartof a process and work together forMary's well being. Mary M. is a 28 year old mildly retarded girlwho the use was placed in theinstitution at the age of 18 by her The case of Diana C. was illustrative of father. He died several years prior to her being of a home visit to reevaluate family resources and to placed in the HIP program.According to the step- reduce the alienation that had taken place between mother and paternaluncle,thefather's death bed family and resident. It also reduced the mother's wish had been that his daughter never leavethe feelings of rejection and disapproval front the institu- last itution. This prominent,upper middle class tion for her failure as a parent. family had already lived through Mary's two pregnancies out of wedlock and thc. violent deathof her Diana was admitted to the Austin State School on mother at the hands of the father.They felt no more October 6, 1965, at tl age of 11, at the request of scandal orseriousbehaviorproblems could be the Bexar County (San Antonio) Juvenile Court. She had been involved in prostitution in the San Antonio tolerated.For more than a year the institotion and step-mother carried on a polite battle bymail, the area and her mother hadthe-reputation of also being step-mother refusingto consent to Mary's working involved in prostitution and was quite limited ed- off campus and the institution building foritself a ucationally and emotionally.Living in a little better pictureof Mrs.M.asthetraditional,rejecting, than an unpainted wooden shack, the family suffered deprivation and unfeeling step-mother..After M. was transferred to fromsevere physical and cultural the HIP project, a heine visit was made byappoint- lived on welfare payments.There was no consistent lrs.C. had opposed ment.The step -,other responded quitepositively to father figureinthe family. the show of intest on the part of theinstitution. Diana's admission to the Austin State School and She was gracious and welcoming andshe arranged her hostility was increased when visitation rights of withsome difficultyfor the paternal uncleto be to her daughter had been restricted at the request Her contacts with Diana were sporadic present.They both had many pertinent questions to the Court. ask, not only about Mary, but about mentalretardation and tenuous. in general, and the institution.It quickly became In August of 1968 when Diana was recovering from obviousthattheratherroutineletter3from the institution had been quite inadequatein explaining a psychoticepisodeduring pregnancy,thestaff 'th her carefulpreparationleadingtoan off-campus job decided that Diana could benefit from contact Numerous efforts to contact the mother by placement. mother. mail proved to be unsuccessful and therefore it was The first visit to the The family's questions regardingpossible sexual decided to re ike a home visit. acting out were frankly answered andthe family was home was made in the company of a Spanish speaking told. that Mary could become pregnant atthe institu- juvenile court worker.Initially the mother refused to tion without even leaving the grounds to go towork. come to the door, and it was necessary toconverse This open acknowledgement of possibleproblems, with her in Spanish through the children whoserved as carefulexplanationof Mary's messenger and interpreter.After some 20 minutes of togetherwiththe sufficiently programs and abilities, andliabilities, led to the family conversation in this manner, Mrs. C. felt and giving consent for off-campus jobplacement.As a reassured that all we wanted to do was talk to her, result of this visit institutional staffcould begin to therefore reluctantly admitted us to the house. We told in a more realistic and positive Mrs. C. about Diana's present situation andcondition, view the family show any lightand as staff dealt with their ownnegative and she asked no questions,neither did she interest. The visit was extremely brief.Shortly after Lion, this man had been arrested in the community on this visit, however, Mrs. C, did write to Diana, and numerous occasions for being drunk and also had marr- much to our surprise, she also contacted the social ied a woman whom his father described as a' ' fallen workerconcerning Diana's general welfare. rive woman". The family was refusing permission for this months later a second home visit was made.This man to go to a half-way house in Houston because time we were immediately admitted to the house and they felt there was "more mischief in a large city." Mrs. C. spoke to us in English. She was less hostile The focus of the social workers in this interview was and showed some interest in her daughter, asking sev- to acknowledge what difficult problems the parents had eral pertinent questions.In contrast to her apparent through outth e. years with their children and to deal disinterest on the first visit, she showed some con- witb concerns for Luther in a very serious way. Assur- cern because Diana had not written as frequently the ances were given that the family did not have to make past two months. She expressed interest in the plans a final decision at this time, and they were encourag- that had been made for Diana's baby, and showed con- ed to talk the situation over with a son and daughter cern that she had not been included in the planning. who were functioning quite wellinthe community. As a result of the home visit, it was possible to es- With this concern on the part of the staff during this tablish some contact between mother and daughter. visit the familyW RSenabled to make further cautious Contacts were considered valuable inthe treatment and rather suspicious inquiry into the half-way house process, as they relieved some of Diana's feelings of programs that existed.After another long and detail-. rejection and desertion.The home visits helped Mrs. ed conference which took place at the institution, at C. to re-establish communication with the institution the family's initiative, the parents rather grudgingly and she continues to correspond with both Diana and gave permission for placement in a half-wry house the caseworker. In addition, she has sent her daughter although they did stipulate that placement must be in some money and other personal articles which repre- a half-way house in Austin, rather than inHoustoti. sent real financial seerifice on her part as there are It was felt the initial home v;sit in which concern was a number of children to be supported on a very limit- shown for all of the parent's problems was probably ed income. the key ti.-tor in this family being able to finally tole- rate their son's move into more independent and re- We feel that without the home visit the mother would spons:.ble behavior. not have re-established contact with her daughter and with the institution. The benefits of the visits extended to the institutional staff for they for the first time Home visits frequently reveal the family's expectations of certain behavior on the part of the resident. cuuld see the mother in a somewhat more positive light It occasionally gave some indication that perhaps the and as perhaps a help rather than a hindrance to the disturbed behavior of the resident was learned behavior. treatment process. Of equal importance is the fact that information received from the visits have helped Diana to know some of the realities of the family sit- This was true in the case of Lupe G. whohas spent uation, rather than having the family only as objects approximately 20 years in one or another State institu- of fantasy. tion for the retarded.At times she had what appeared to be a psychotic episode and she would become vio- In the case of Luther E. a home visit enabled the lently angry, would throw things and threaten staff and social workers to share with the rest of the HIP staff residents.In the first home visit made to the mother a vivid picture of the serious pathology that existed in at least Li or 6 years, she described Lupe's father's in this family. To know that 2 of the 6 children in the behavior quite vividly.lie would have violent temper family were schizophrenic and that one af .t1- em had tantrums, threaten to kill himseli and in general, frigh- been hospitalized for nearly 20 years, was quite dif- ten everyone in the family. The mother's expectations ferent than going to the home and seeing the parent's were quite obviously that Lupe would be like her father rigidity and n-,er-coneern.To have the interview in- and would be somewhat "queer in the head."This terrupted by one son recently released from the psy- information gave the staff some new insights eod led chiatric hospital who kept banging large potted plaats to consideration of new ways of working with this down on the porch because he was angry about the disturbed young woman. This is not to say that Lupe interview, and seeing the family's reaction to this, no longer has disturbed episodes, but there is a bet- gave many more clues as tothe family's concern ter understanding of some of the things which have about their son, Luther. Prior to coming to the institu- led to her present adjustment. 0 It cannot be said that all home visis were suc- in the communityand creating difficulties.The fam- cessful in accomplishing their purpose or in building ilyis afraidif re-admission is necessary, it would a meaningful relationship and communicationbetween perhaps take some months and years such as was nec- the institution and the family.Frequently both the essary to accomplish institutionalization in the first staff of the institution and the family have continued place. to view each other in a negative and hostile way. The If visits to families are shared freely with institu- staff still frequently feels that the family must con- tional staff and if the social worker can view himself sent without undue delay to whatever the institution as an intermediary, helping institutiou and family to proposes for a particular resident; that if theydo not understand the position of the other. then a freer flow care to do this, then theyshould remove the resident of communication can result so that a mutuality of in- from the institution.The family on the other hand terest can be established that will be for the benefit often continues to be feurful about the resident being of the resident. PART VIII

Social Work Graduate Training in The HIP Project

Ralph M. Scheer,Aavy Social Work Specialist 1. Introduet ion: The 1950's witnessedasocialpropulsion toward a recognition of the mentally retarded as a group which needed and deserved to be sersed by the social Priortothe mid-fifties there existed few close work profession. Social work educators began to devel- bonds between mental retardation and social work op work shops, institutes and seminars to put this graduate education.The reasons for this gulf were needed recognition into practice.In 1959 an institute many. first, most services forthe retarded were cen- entitled, "Mental Retardation Content in the Social teredinlargestatesupportedinstitutions which Work Curriculum'. was presented at the University of were custodialin philosophy and practice.These Utah Graduate School of Social Work.This pioneer institutions were set up based upon the medical rather instituteaddresseditself to three questions: (I) thanthe psychiatric model with the roleof social Row best to apply basic social work principles to the workers being rigidly or poorly defined.Secondly, problem of mental retardation,(2) What content .egard- there then existed prevalent beliefs that service to the ingmentalretardationshould be emphasized and retarded was a "futile endeavor wherein little sat- how should it be incorporated into the basic class isfactionscould be derived from becoming profess- and field curriculum of the school and, (3) What are ionally involved. Educators in schools of social work the most effective methods of teaching students in were frequently in agreement with manyof these pre ju the field and classroom positive attitudes and sound dices regardingthe retardate. Consequeetly, social philosophy in this area? work education offered little, if any,attention to a cog- nizance of the social work challenges existing in pro- As the 1950's can be labeled a period of parent viding services to retardates and their families.Us- interest in the mental retardation, the 1960s can be ualls- the only classroom exposure to the problem of labeled a period of governmental involvement.During mental retardation offered students was thumb sketch- the presidency of John Kennedy, the fede,al govern- ed in a single case study record. (The Rose Stein ment recognized the urgency of the need to become case).Although social work students and profess- activelyinvolvedinplanning,training staff,con- ionals frequently came into contact with retardation ductingresearchandup-gradingservicestothe in meeting their responsibilities in many settings such retarded.The r resident's Panel on Mental Retarda- as public welfare, school socialwork, neighborhood tion of 1961-62 made public, "A Proposed Program workandfamilycounseling,theydevotedlittle for National Action to Combat Mental Retardation... energies per se to the study of mental retardation as This monumental work delineated through the reports a family and/or social problem. of a number of task forces many of the existing gaps in services and resornmended a comprehensive plan During the mid-fifties a social awakening regarding ofaction. From the work of this panel came the the retarded occurred.In the 1930's parents demand- establishmentof such governmental groups asthe ing a variety of educational, vocational and recrea- President's Committee on Mental Retardation, The tionalservicesfortheir retardedchildren formed Secretaries Committee on Mental Retardation, and the local chapters of Associations of Retarded Children. Meatal Retardation Division of the Social and Rehab- These began to spring up as a grass roots movement ilitation Service.As Washington provided the lead and eventually led to the creation of the National each state and local governmental structure followed Association of Retarded Children.This organization suit. by 1950 had over 60,000 members; both parents and professionals.By 1954 there were over 600 chapters As money for traineeships became available in a in the country.Gradually, as institutions were re- varietyof disciplinessocial work scholarshipsin sponsive to parent demands to up-grade services social retardation became numerous. service departments became an established and valued part of institutional services.The creation of these Inthe 1950'sthere existed a small handful of social service departments as professional services social work graduate students being placed in mental staffed with trained social workers made possible the retardation settings.By the late 1960's almost every placement of graduate students.Prior to this time it school of social work ha..j graduate studentsaffili- had been virtually impossible to find qualified social ated with MR servicesin either a casework, group work supervisors in these institutions. Previously the work or generic sequence.In 1962 the University of milieu within these institutions were notconducive Texas, School of Social Work, began to use the Austin to the standards required for social work education. State School as a field placement. 7 3 7 In 1966, report by the American Association of it became apparent that although The University of MentalDeficiency, Committee of Social Work Ed- Texas was interested in cueing into the HIP project ucation, discloses the following findings: in a collateral and consultive relationship, nevertheless, the assigning of graduate students to the HIP 1. 336 full-time students, or 5.6% of the total project for the field assignment seemed unfeasible. enrollmentof schools of social work is placed in mental retardation programs. The Worden School of Social Service at Our Lady of the Lake College in San Antonio, which had a long 2. Of 55 schools responding, only 16 had no history of interest in group services, was approached students placed in mental retardation, and of these regarding th6r interestinutilizing the HIP grant 16-10weredevelopingprogramsfor1966-67. as a MR training placement.Preliminary conferences were conducted during 1966 both atthe Austin State 3. Of the 57 student field units, 30 were in Schooland at Our Lady of the Lake College in residential institutions. preparation for beginning of placement of students. OnJanuary 3,1967,thefirsttwo students were 4. Of the 57 units currently operating (as of assigned to the HIP grant with Mr. Ralph M. Scheer spring, 1966) 42 were developed since 1962. as field i,structor. able to Thus,itis quite obvious thatinthelast 5 Many schools of social work have been years there has been a tremendous upsurgeof interest hirefulltimefacility personnel to serve as unit by the schools of social work in the care and treat- field 'nstructor.These university employed facility ment of the mentally retarded.This has in large persons are placed in the agency tosupervise grad- been spear-headed by die many federal grants which uate stud,znts and yet by the administrative structure have flowed inthis direction.This can be clearly areresponsble forbridgingthegapthat exists seen in the funding sources for the57 student place- betweea classroom and field instruction. However, ments. Thirty-eight ofthefieldplacements have many schools of social workstill rely heavly upon An agency beenfunded by Federal agencies, while only 14 the agency " practitioner-supervisor." have been funded by the participating agency and supervinor must serve in a dual capacity; theneeds only a scant 4 placements have been founded by the ofthe agency and also those of stndents. This schools of social work. additional supervisory responsibility usually results in longer work hours, additional workresponsibilities Why then do many II. Placement of Students within the HIP Project and rarely any additional salary. professionals relish the opportunity?Many factors profesaional growth and status, intel- Dr.Philip Roos,former superintendentof the are involved AustinStateSchool,inoutlining the HIP grant lectualstimulation, and the opportunity of having proposal suggested, ' Professionals intraining students who forcethe professional to take time such as graduate students in psychology and social away from day to dayroutine practice and to take a work would also be assigned to the project on a fresh perspective as to where he has been,where he rotating and/or part time basis."Thus it naturally is, and where he is going.Nothing can sharpen a followed that as soon as the grant became operational professionalsmotivationforpracticecompetence that overtures were made regarding the feasibility of than being forced to serve as a role modelfor stu- offeringthe HIP grant as a training program for dents. social work education. III. Value of an MR Student Placement Initially, The University of Texas was contacted since their physical proximity made that school the logical choice. However, due to several factors (1) When a studentis placed at the Austin State the already established existence of a student unit School he is immediately challenged in his learning with a full time field instructor at the Austin State on three different fronts.Pima, he must learn social School;(2)theprimarycommitmentto casewu.' work; social work which is applicable to variety of services of the School of Social Work tended to create settings: publicwelfare,neighborhoodcenters, a reluctance to develop aplacement where a heavy housing projects, wherever social problems exist. focus would be centered on group services.Thus, Secondly, much of what the student needs to learn is basic to an understanding of menwl retardation as a out a field placementin MR voluntarily the follow personal,familyandsocialcommunityproblem. ;rig global objectivesfor the student program were Thirdly. the Austin State School being an institution outlined: has a social dynamic environmental force. In order forthe studenttobe able to gain proficiencyin 1. A developing appreciation for the mentally professional practice. all three areas must be covered retardedas a social problemgroup deserving of sinlultaneouslvandincorporatedinaneducation social services. network predicated upon knowledge skills and values. 2. An ability to appreciate the t.-!,cessity of Certainly, much of what is generic to successful utilizinga problemsolving approachto practice social work practice is also incorporated into place- and in keeping with this recognition the development ment in a residential program for the retarded.Inter- of professional skills and know;edge in a variety of viewing, intake, counseling, development of resources, socialworkmethods,includingcasework,group group work are all vital parts ofan MR placement. services, and community development. However, it would appear that an MR student placement in addition offers something unique.Few other 3. The abilityto workprofitablyin a multi- settings offer the student the opportunity to test out disciplined setting with a reeognitionfor the con- quiteassharplybasicconceptsofsocial work. tributionofeachprofession. Through concrete How does thesocial work student deal with the learning experiances to cue into the knowledge base conceptofself-determinationinsettings wherein ofavarietyoftheseapproaches,i.e..behavior self-determinationis unknownindealing with res- modification,etc. idents? How does the student demonstrate respect for the rights of the individual when conformity is the 1. The student was .expected to demonstrate rule. (Itis not the author's intent to chastize the anawarenessoftheinstitutionalmilieuand to institution, but rather merely to point out that often therebyassess the influence of that milieuin the this social system is entirely in contrast to principles rehabilitation process. The student was also expect- being taught as basic social work ideology.) No edtolearn howtofunction as an environmental othergroupinsociety has been devaluedto the engineerinhelping to bring about positive milieu extentthat befalls the retardate.Once again the changes where eeeded. student is faced with the necessity to put to the test hisfeelings about people.Does thesocial work 5. The student was encouraged to intellectually principle of respect for the dignity of each human develop through written material whilein placement being apply in equal measure to those still referred sincefrequently materialreadinrelationtocon- to as sub-normal?The placement of the student at crete practice tends to be most meaningful. the Austin State School hopefully allows the graduate studentnotonlytheopportunitytodevelop his 6. The placement,it was hoped, would help competence as a technician, hut far more important, the student have an opportunity to explore his own theplacementhascreatedastimulating milieu personal and professional philosophy and goals so as wherein he was required to focus his attention in- to lead to clearer self definition of both their ex- ward toward himself as a social thinker. pectationsofsocial work practice and their con- tributionto social work practice. IV. Educational Objectives and Goals 7. Although notemphasizedtotheextent Arecent study(Begab1968) 'The effect of necessaryit was intended that the field placement Differencesin Curricula and Experiences on Social shouldhelp thestudenttolearn professional re- Work Student Attitudes and Knowledge about Mental sponsibilitiestowardwriting,record keeping,re- Retardation" has indicated that only 4% of the stu- portingandresearchasprofessionalobligations dentsinterviewedlisted servicestothe mentally which are service based and inter-reiated. retarded as their first preference as a client group. Moststudentswithoutpreviousexposuretothe Because of the past stereotype social service mentally retardeddemonstratedunfavorableat- to the retarded as a "dead-end"setting with very tidues toward this group.In keeping with the rec- littlepersonalor professionalgls.nour,thefield ognition that few social work students initially seek 'nstructorattemptedtodemonstratethroughfield practiceexperiencesthatsocialservicestothe ity" addresses himself to the strong biases which mentally retarded indeed offered an enriching chal- existparticularly intheeducationallyoriented lenging educational experience. cultureregardingstupidity. Therefore,thefield instructor must first break down negative bias which The goals for the placement were essentially: may have been nurtured from infancy.In addition to the problem involvedinplacement relatingto the I.To prepare the students for entry into the retarded themselves the student must also face the socialwork professionwiththenecessary qual- additional and sometimes even more difficult task ifications to practice in a variety of settings. of cueing into an institutional milieu. The largeness, the impersonableness is often over-powering.Thus, 2. To provide the students with an exposure complicating the normal anxieties facing any social to mental retardation which would allow the student work studentin placement, the students placed at to feel adequately prepared to offer serViCe La the theAustinStateSchoolfacedseveral anxieties retarded or their families even though in the future unique to the setting itself.However, much can be they might not be affiliated with an agency whose done to counter-balance these anxieties and to help specific concern was MR services. the student feel more at ease. The usual orientation approachitself,introductions,record reading, and 3. To encourage students to investigate the case study can be greatly modified and improved. setting of MR as an area of specialization. Thus, For new students to quickly come face to face in a to move into professional practice within this setting. relaxed social encounter with a "real live retardate does much to remove the anxiety.The field instruc- V. Students Characteristics torgoing withthestudentstotheCanteen and letting them take part in a "bull session" between BetweenSeptember, 1967andJanuary, 1970, theinstructor and one of his retarded clients can 4 field placement semesters transpired.Each of the help get things off on the right foot.Since students semesters the students wereplaced atthe Austin invariably come directly from a classroom setting State School for a period of 16 weeks.They were and are book focused, some light reading such as responsible for working a 40 hour week, or approx- Pearl Buck's,The Child Who Never Grewyor Carvel imately 650 work hours per student per semester. Lee's,Tender Tyrant; might prove of valee inhelping Inall, 7 social work students were affiliated with the student make the transition.Above all, the field the grant.Two students were in placement in 1967, instructor must not lose sight of theinitial shock 1 student in 1968, 2 students in the spring of 1969, usuallyinvolved when a person forthefirst time and 2 students in the fall of 1969. attempts to enter a state school setting.

Ofthe 7students served, 2 werefirst year VI. Direct Services students and 5 were second year students.Six of the 7 students wore women, Three of these students A. Group Services: Due to the past experiences were nuns.Two of the students had previous full- and training of the field instructor, group services timepaidsocialwork experience and another 3 undoubtedly played a predominant part int!,etotal had gone into graduate school with prior teaching field instruction experience.Over the 4 semesters, experience.Only 1 of the students had in the past students worked with 19 different groups of residents. worked directly with the mentally retarded or their Inall,163 residents were served ingroups. As families. should be the case, groups were not formed merely from within the FHP project, but rather residents from VI. Student Orientation 10 different cottages were involved in these group experiences.Although by their very nature, each of Since work with the mentally retarded isct. new these groups were socialization groups in focus (as experience for most students initial exposure tends this is the primary function of residential placement) to be of paramount importance.Usually a student eachgroup'sspecific approach was individualized views a MR placement with considerable anxiety and accordingtosuchfactorsasage,rehabilitative feels that he has little commoninity with his clients programsin which the resident was involved, and to be.Louis Dexter in his book, "The Tyranny of immediate programming goals. Each group was formed Schooling: An Inquiry Into the Problems of Stupid- based not upon agency need but rather first priority was allocated to the educational needsof the stu- eventuallyledtohis acceptanceintothe Army. dents;thus a divergencyin age,functioning lesel Intheprovisionof casework services the student andsex was soughtinassigning groups. Each wasexpected to work not only directlywith the student had either 2 or :3 group assignments.These resident clients but whenever feasible to intricately groups met either weekly or twice weeklypredicated involve their families.This was often not possible uponthatgroup's particular needs. The student to thedegreedesired, by either the student or the took direct responsibility of selecting at least one instructor,duetothegeographical distance from of the groups for which they were to take responsi- Austin of many families.The social work student bility. Each student was responsible for program wasexpectedinalldirectservicesto view his planning,directworkwiththegroup, counseling servicenot as anisolatedprogramming endeavor withindividual group members when needed, com- but instead to dovetail his energies into the total municatingtheirservicestotheresident's home Austin State Schoolstaff rehabilitationeffort. In dormitory,andevaluatinggroupprogressthrough this way the student was able to form a meaningful bothverbalconferenceswiththeinstructor and understanding of thefunction of various discipline record keeping.All groups to a varying extent made contributing to the rehabilitation process.Likewise, usenotonlyofverbalcontent,but of concrete thestudent was expectedtointerp ethis direct programexperiences. Withtheinstitutionalized services as well as social work coneepts to both retardedit was considered particularly important to sub-professionals and professionals. allow thegr.17) members an arena in which to test out social reality through concrete programactivities and to thus use group sessions to deal with feelings C. Supervisionof Staff: Duringthelast2 around these program experiences. A trip to a depart- placements the ssidents were offered an opportunity ment store, for example, resulted in several sessions toworkina supervisory-consultant capacitywith devoted to what people think of the retarded, and attendant staff.It was hoped that this experience also the teen-age group members animosity regarding would not only provide the social werk student an institutional staff members lack of trust. opportunityforlearningto supervise(afunction which many social workers find themselves immediately after graduation) but thatthis ex- er chstudent,in assigned to B. CaseWork: Naturally, perience would also help the student to more fully addition to group assignments, also carries a number appreciatetheeffectoftheresidentialcottage of cases for which he was responsible. Each student the problems Inall, 31 milieuupontheresident;likewise, was assigned between 3 and 5 eases. milieu along therapeutic residents were seen in casework situations.Cases inherentinmolding this were again often selected by the studentthemselves with the agreement of the field instructor and predicated upon their learning value.The very nature of thecasework relationship created problemsin as- D. Cottage Involvement:In an institution many signing a student caseworker for a short 16 week times there exists a gulf between the world of the periodthat usually did not exist in a group work professional and that of the attendant in the cottage relationship. The field instructor attempted to select (Polsky1964). Professionalservicesareoften cases that would offer learningvalue for the student. undermined by the attendant (and vice versa) because (All too oftenin state schools cases are selected st a lack of recognition of each others contribution. Frequently these cases de The field instructor feels thatthe most successful as "solely supportive." the rehabil- notoffer the student an opportunity for succsssful way to counteract this destruction to conclusion and therefore they may prove frustrating itationeffortisbytheprofessionalphysically to the student and the resident aswell.) To avoid involving himself into eottage programming. Each thispit-fall,cases were selected duringstrategic student therefore was expected to devote 5 hours per developments for the client.Loss of employment week to cottage involvement.This included such in the community, preparation for communityemploy- things as helping plan or chaperone a cottage dance, ment, a pending transfer betweenbuildings, prepara- taking residents shopping, or crucial activities such tion for a half-way house placement, a familycrisis, as having "bull sessions" withthe attendant staff. all tended to be crucial times for casework inter- The students success in these cottage related activ- vention.Probably the most dramatic instance was a ities could in large measure determine his success case assigned of a psuedo-retarded young manwhich in casework or group work services. \ Other AdliN staff.

A. Program Exposure: As was implied earlier VIII. Supervision: an institutional placement can and shouldhe an enrichingexperience. Inlargemeasurethisis A field placement offers 2 basic values. First. the predicated upon theinterest,creativity and motiv- setting and the experiences which are inherent in the ationof the student and should be encouraged and milieu.Secondly, the skill and interest of the field thesupervisory promoted bythefieldinstructor. Atthe Austin instructorasmanifestsitselfin State School students were offered the opportunity relationship. In most instances (withall due im- and expected to take advantage of many diversified modesty)itisbelieved thata productive teaching This learningopportunities. The stndents engagedin relationship with the students was developed. training sessions with members of various disciplines relationship helped the students to take advantage learning opportunities which existedinthe and a varietyof specializedgrants. They were ofthe exposed to. among others. vocational rehabilitation, placement. Variousformalandinformal devices psychological services, a foster grandparents grant, were used to bring theeffective use of supervision adulteducation, a physicaleducationgrant and into being.In addition to formal individual and group social service functions: supervisory conferences, the field instructor attempted to make himself available at all timesfor informal drop-in'bull sessions. B. Comma in), Field Trips:The students were likewise not expected to limit their exposure to the inviting thestudent over to Since the purpose of placement was to Such activities as institution. supervisor's home for dinner and going out to trainsocial workers and not MR specialists,the the students were expected to avail themselves of com- lunchtogether tended to iatmanize the relationship. munity learning opportunities. Each week the student It is firmly believed that the supervisor will himself set the stage regarding how the studentperceives selected a community program for a field trip.They working at the State School.The supervisor must among others.suchplaces asa special visited, attempt to be enthusiasti, and be able tocommunicate treatment unit at the Austin StateHospital, a senior LO the students bothth,.:challenges and the frust- citizensactivitycenter, a behavior modification rations of the job, program forchildrenwithlearningdisorders, a residential school for the emotionally disturbed, an IX, Conclusions: agencyfor unwed mothers, and a residential Year round camping program for delinquents. The institution during the last 4 semesters has offered 7 graduate students an opportunity to enrich Students also were encouraged to develop their Basically, the institc- through attending sessions of their professional education. professionalidentity Lion has been positive and appreciative of the efforts thelocalchapterof theNational Association of made by the students.Five of the 7 students have Social Workers and the Texas Social Welfare Asso- completed their education and are now employed as at i on. professional social workers.The other 2 will complete their education in June.The 5 students who C. Committee Meetings: An important part of and placement is the learning which takes place by have graduated are employed in a variety of agencies. one works with drug addicts, onedirects a children's accepted as an integralsharing studentsbeing another works as asupervisorat another member of the host staff.'f'he IIIP staff atteninled in home, offer the students this type of children's home, one is doing missionary work in the varying degrees to Islands, and the last is a supervisor at a Associ- acceptance. The HIP staff wascomposed of persons ofRetardedChildren. representing various disciplines.This had the effect ation of creating less of an investment in theteaching of social work students than is usually the ease when Recommendations: the host agencyis a Social work agency with all professionalsocialworkers who themselves have Serving in the capacity of field instructor during experienced field placement.Nevertheless, students the past several years.it would seem that many of did participate in staff meetings, committeemeetings, the staff and administration have not recognized the and the internal problems and affairs of the grant potential that graduate student training has to the

cra Atttia state School.In speaking aith students in ahead.Considering that Th e nixers Texas is it would appear bothunitsiiwould seem that inuch' the largest unkersitv in the south. gii curs needlessly. Students oftenfallin a thatopportunitiesforstudent placementsinelan% never-never laud betweenvolunteers and professional discipl ines have been completel negleted. staff where no role guidelines exist.Hopefully as Speech and Audiology. Sociology, Special Education, students continue to he placed at the Austin State Social Work, Psychology. Vocational Rehabilitation, lindcrgraduateEducation.Public Welfare Adminis- School the administration will gain a greater appre- tration. Nursing seem to all be fertile ground forthe ciationoftheircontribution,notonlyregarding development of extended educational experiences in directservicesduringplacement,butequally as internships or field placements.Possibly a student important for their value in public relations forthe trainee grant could be submitted to create aposition retarded and for the Austin State School in the years to work in this crucial area.