DOCUMENT RESUME - ERIC · DOCUMENT RESUME ED 250 899 EC 171 137 AUTHOR Kozlowski, Ronald E.; And...

DOCUMENT RESUME

ED 250 899 EC 171 137

AUTHOR Kozlowski, Ronald E.; And OthersTITLE Future Directions in Adult Services. Position Paper

Nu. 3.INSTITUTION Ohio State Univ., Columbus. Herschel W. Nisonger

Center.SPONS AGENCY Ohio State Dept. of Mental Health and Mental

Retardation, Columbus. Div. of Mental Retardation andDevelopmental Disabilities.

PUB DATE Feb 84NOTE 49p.; Funding was also provided by the Ohio

Developmental Disabilities Council. Prepared by TheCommunity Services SubcommitteeDeinstitutionalization Task Force. For relateddocuments, see EC 171 135-139.

PUB TYPE Viewpoints (120)

EDRS PRICE MF01/PCO2 Plus Postage.DESCRIPTORS *Adults; *Deinstitutionalization (of Disabled);

*Developmental Disabilities; Models; *ProgramDevelopment; *Services; Sheltered Workshops;*Vocational Education

IDENTIFIERS *Ohio

ABSTRACTThe third in a series of position papers regarding

deinstitutionalization of individuals with developmental disabilitiesin Ohio, the paper addresses future directions in adult services.Basic planning principles guiding the delivery of services arebriefly reviewed, followed by a list of five objectives of adult

Trams. The next section describes the traditional continuum of daypm:Jram options for adults with developmental disabilities (rangingfrom regular employment and on the job training to adult day care andno day program) and suggests the negative aspects of such acontinuum. Federal, state, and local constraints to the developmentof adult services in Ohio are noted. Three fundamental prerequisitesof any such service delivery strategy are examined. Utilization ofgeneric services, case coordination, and prevocational training. Therole of day programs is discussed, and the importance of focusing onindividual needs, providing the most culturally normative settingpossible, and ensuring a range of vocational options (includingsheltered workshops) is emphasized. The traditional and proposedapproaches to providing vocational services are contrasted via casestudies of persons with severe, moderate and multiple handicaps andsevere behavior problems, and older and currently unserved persons.The report concludes with general recommendations along with morespecific ones in the areas of planning, funding,monitoring/evaluation, and training and technical assistance. (CL)

*********************************************1.*************************Reproductions supplied by EDRS are the best that can be made

from the original document.***********************************************************************

POSITION PAPER NO. 3

Future Directionsin Adult Services

U.S. DEPARTMENT OF EDUCATIONNATIONAL INSTITUTE OF EDUCATION

EDUCATIONAL RESOURCES INFORMATIONCENTER (ERIC)

gel This document has been reproduced asreceived from the person or organizationoriginating it.

(.1 Minor changes have been made to Improvereproduction quality.

Points of view or opinions stated in this docu-ment do not necessarily represent off.zIal NIEposition or polry.

"PERMISSION TO REPRODUCE THISMATERIAL HAS BEEN GRANTED BY

Ronald E. Kozlowski.

TO THE EDUCATIONAL RESOURCESINFORMATION CENTER (ERIC)."

Prepared by The Community Services SubcommitteeDeinstitutio rialization Task Force

2

Total copies printed: 900Unit cost: $ 1.2833Publication date: 2/84(Includes paper coats)

3

POSITION PAPER NO. 3

Future Directionsin Adult Services

Prepared byThe Community Services Subcommittee

Deinstitutionalization Task Force

Ronald E. Knzlowski, Project CoordinatorWade Hitzing, Task Force Member

Elsie Helsel, Subcommittee Chairperson

The contents of this paper reflect official policy and positionsof the Ohio Developmental Disabilities Planning Council.

December 1983

4

"IT HAS BEEN REPEATEDLY DEMONSTRATED THAT SEVERELYDEVELOPMENTALLY DISABLED INDIVIDUALS CAN LEARN TOPERFORM THE COMPLEX SKILLS NECESSARY TO PRODUCE A rA "NORMAL" RATE IN SHELTERED WORK, OBTAIN AND MAINTAINCOMPETITIVE EMPLOYMENT, SHOP AND PLAN MENUS, BE MOBILEIN THE COMMUNITY, BE SOCIAL, SOLVE FUNCTIONAL MATHPROBLEMS, AND READ. IT IS CLEAR THAT t PRIMARY BARRIERTO COMMUNITY INTEGRATION IS NOT THE SKILL DEFICITS OFSEVERE:Li DEVELOPMENTALLY DISABLED INDIVIDUALS, BUT THELACK OF SUFFICIENT INTEGRATED COMMUNITY VOCATIONAL,RESIDENTIAL AND RECREATIONAL OPPORTUNITIES AND THEABSENCE OF APPROPRIATE PROGRAMS TO TRAIN THEM IN THESKILLS NECESSARY TO GAIN ACCESS TO THESE0 P PO RTU NITI ES."

Paul Wellman1981

"VOCATIONAL SERVICES ARE USUALLY CONTROLLED BY LARGEBUREAUCRATIC AGENCIES WHOSE POLICIES ARE WELLESTABLISHED AND WILL NOT BE SUDDENLY DISCARDED. IN THISREGARD, SARASON (1972) HAS SUGGESTED THE DEVELOPMENTOF NEW SETTINGS, OR MODELS, RATHER THAN THEREARRANGEMENT OF OLDER MALFUNCTIONING ONES.HOWEVER, ALTERNATIVE MODELS MUST BE CAREFULLYDESIGNED TO AVOID THE MISTAKES AND SHORTCOMINGS OF THEONES THEY ARE INTENDED TO REPLACE."

David PomerantzDavid Yarn° lm II

1977

This paper reflects the official position and policy of the Ohio DevelopmentalDisabilities Planning Council. The development of this paper was supported by fundsmade available through a grant from the Ohio Department of Mental Retardation andDevelopmental Disabilities, authorized under P.L. 95-602 to further the attainment ofthe goals and objectives of the Ohio Developmental Disabilities Planning Council.

The contents of this paper do not necessarily reflect the position or policy of theOhio Department of Mental Retardation and Developmental Disabilities, and no officialendorsement of the above agency should be inferred.

it

CONTENTS

Preface

Acknowledgments vii

Adult Services

Basic Planning Principles

Least Restrictive AlternativeRight to ServicesNormalization PrincipleEqual JusticeRespect for Human DignityDevelopmental AssumptionEffectiveness and Economy

1

1

Objectives of Adult Programs 4

Critical Analysis of Current Plans

DescriptionNegative Aspects of Continuum

Adult Services in Ohio

Criticisms of Day ProgramsMajor Constraints

Whole Person Approach

Fundamental Prerequisites

Generic ServicesCase CoordinationPrevocational Training

5

8

11

12

Day Program Services 17

Role of Day ProgramsFocus on Individual NeedsSettings Separate from Vocational

Vocational Options in the Community

Workshops

Traditional vs. Proposed Approaches

Person with Severe DisabilitiesPerson with Moderate Disabilities

20

21

23

Hi

Persons with Special Nceds 26

Persons with Multiple HandicapsPersons with Severe Behavior ProblemsOlder PersonsCurrently Unserved Persons

Recommendations 29

GeneralPlanningFundingMonitoring/EvaluationTraining and Technical Assistance

References 32

Appendices 34

Deinstitutionalization Task Force inside back cover

Community Services Subcommittee inside back cover

iv

PREFACE

Changes in the philosophy of services and a growing concern for therights of persons with developmental disabilities have led to a nationaldeinstitutionalization movement. Thus, the service system for Ohio's citizenswith developmental disabilities is in a period of transition as the state movesfrom an institution-based to a community-based service delivery model. Althoughthe deinstitutionalization movement has increased the move toward community-based services, numerous constraints continue to challenge this effort. Withthe transition in progress, the development of long- and short-term servicedevelopment plans is critical to the evolution of a cohesive system that uniformlyprovides appropriate and adequate services. Identification of the nature endshape of the desired service system, the recognition of existing and potentialconstraints, and the development of an effective planning process must occurto assure that quality services are available now and in the future.

It is within this context that the Ohio Developmental Disabilities PlanningCouncil created the Deinstitutionalization Task Force Project. The purpose ofthe project was to establish and provide staff support to a DeinstitutionalizationTask Force, wnich was formally constituted in March 1981. The Task Force,composed of representatives from various agencies and consumer groups (seeinside back ,:lover), was charged with the responsibility to identify major issuesrelated to deinstitutionalization and to develop recommendations for increasingthe availability of appropriate services to persons with developmentaldisabilities.

Given its charge, the Task Force had two major options in terms of whereto focus its attention: (1) on the nature or structure of the service system or(2) on the service process. Because of the scope and complexity of the issuesrelated to deinstitutionalization, the Task Force decided to focus on the natureor structure of the service system. This approach Was chosen because (1) anappropriate structure is a necessary condition for the development of quality,appropriate services and (2) many process guidelines and safeguards are alreadypresent in rules and regulaams. By focusing on the structure of the servicesystem, the Task Force could then develop a plan containing: (1) a broadoutline of the proposed service system and (2) a broad outline of proposedplanning strategies.

The Task Force considered this option al most consistent with theDevelopmental Disabilities Plaailing Council's advocacy function, in that thedevelopment of a broad outline of the proposed service system facilitatessystemic change. Long-range service goals define how things "ought to be"and car. be used to guide short-term transition planning.

The Task Force initially sought to identify the various legal andphilosophical principles in the field of developmental disabilities and to definewith a high degree of clarity the actual issues surrounding deinstitutionalization.These deliberations were based on experiences in Ohio and augmented by theexperiences of some of the more active state programs outside of Ohio. Thebasic concepts that emerged were used then to guide the planning process.

Preface

This led to the second step, which was to apply these concepts to aservice system for persons with developmental disabilities. The Task Forceselected the following broad areas in which to concentrate its efforts: (1)the role of institutional services (2) residential services (3) adult services (4)informal and formal supports, and (5) administrative structure and finance. Toprovide broad-based professional and consumer input in addressing these generaltopical areas, a subcommittee structure was established. The followingsubcommittees were constituted by the Task Force:

o Institutional Services Subcommitteeo Community Services Subcommitteeo Prevention of Institutionalization Subcommitteeo Finance Subcommittee

This structure essentially provided a two-tier review process. Eachsubcommittee was charged with the initial development of a position paper ona selected topic. The Community Services Subcommittee was charged withinitial development of position papers on two topics. The papers were thenall submitted to the Task Force for review and/or modification, and subsequentlyadopted as official position papers of the Task Force. The five position papersprovide statements of program philosophies and service strategies that can beused to develop quality services for persons with developmental disabilities.Each position paper contains a series of broad recommendations that the TaskForce believes should be used in developing specific implementation plans.

The Task Force believes that the position papers describe a realisticdirection for Ohio's service system and should be used as roadmaps for developingquality services for persons with developmental disabilities.

Papers in the series include:

Position Paper No. 1: THE FUTURE OF INSTITUTIONAL SERVICESIN OHIO:Do We Need to Plan for Institutional Services?

Position Paper No. 2:




Nisonger CenterThe Ohio State University

vi

RESIDENTIAL SERVICES IN OHIO: The Needto Shift from a Facility-Based to a Home-Centered Service System

FUTURE DIRECTIONS [N ADULT SERVICES

PROMOTING QUALITY COMMUNITY LIVINGTHROUGH FORMAI. SUPPORT SERVICESAND INFORMAL SUPPORTS

FUTURE DIRECTIONF, [N AD V1INIS'TRATIVESTRUCTURE AND FINANCE: PREREQUISITESFOR COMMUNITY-BASED SERVICE.

Ronald E. KozlowskiProject Coordinator

frl

ACKNOWLEDGMENTS

The Deinstitutionalization Task Force Project was originally established througha letter of agreement between the Ohio Developmental Disabilities PlanningCouncil, The Department of Mental Retardation and Developmental Disabilities,and the Ohio State University Research Foundation (Nisonger Center) to identifyissues and develop recommendations relative to deinstitutionalization in Ohio.The products of the Task Force are the result of a collaborative effort byvarious individuals, representing a variety of organizations and agencies, whoparticipated on the Task Force or its subcommittees, or otherwise providedassistance in developing the various position papers. Forty-two individuals,representing thirty-three organizations and agencies, contributed to thedevelopment of the five papers. Appreciation is extended to those individuals,who graciously gave their time, patience, and expertise.

special mention is made of the sincere efforts that were put forth byDr. Jerry Adams, who conceived the project and devoted tremendous personalenergies toward making project activities viable. Succeeding Dr. Adams,Dr. Denis Stoddard also devoted much personal energy in supporting the project.Dr. William Gilbert and Dr. Henry Leland (Co-chairpersons) guided the TaskForce through its deliberations and saw to it that the Task Force completedits tasks. Appreciation is also expressed to the Ohio Developmental DisabilitiesPlanning Council for recognizing the significance of this project and providingfunding for its activities, and adopting the position papers produced by theTask Force as official policy and position statements of the Council.

vii

10

Planning Principles

Adult services programs should provide assistance toADULT SERVICES persons with developmental disabilities so that they may

attain maximum:

o Independence and human dignity

o Presence and participation in community life

o Status as valued community members

o Potential for growth and development

The main goals for adult services should be to: (1)meet the person's habilitation needs (2) enhance employabilityand financial independence (3) facilitate placement in valuedjobs (4) ensure opportunities for leisure time/recreation and(5) provide necessary support services. Adult programs shouldattempt to maximize the ability of individuals withdevelopmental disabilities to participate competently in abroad spectrum of community activities. It should be notedthat these goals can be achieved without neglecting theperson's special needs for supervision and care.

A necessary first step in the development of a system-BASIC atic approach to delivery of services to adults with develop-

PLANNING mental disabilities is the delineation of principles upon whichPRINCIPLES the service system must be built. These principles, which

reflect basic philosophical and ethical concepts in the field ofdevelopmental disabilities, should guide the planning,development, and implementation of adult services.

LEAST RESTRICTIVE ALTERNATIVE

The principle of least restrictive alternative requiresthat day programs and services be the most age and culturallyappropriate for meeting the person's need for supervisionand training, without imposing unnecessary modifications ordenial of personal rights. A further consideration is thatthe service and the setting be based on the person's needs--not just on the options currently available. For instance,a person should not be placed in an activity center if, withtraining and supports, he or she could function in regularemployment or a less restrictive vocational setting. Trainingprograms and habilitative services should be geared towarddeveloping useful skills and promoting independence, and notmerely providing "babysitting." In addition, if the ultimategoal for all individuals is to promote as much independenceas possible, the appropriateness of large segregated settingsmust be questioned. How does the congregation of largenumbers of persons with developmental disabilities in

1

2

Planning Principles

physically and socially segregated day programs contributepositively toward enhanced independence and competence?

It is important to point out that application of theprinciple of least restrictive alternative does not mean thatall persons can be placed in regular employment. However,application of this principle does require that placement insettings more restrictive or segregated than regularemployment be proven as necessary to meeting the person'sneeds.

RIGHT TO SERVICES

Right to services concerns the right of persons withdevelopmental disabilities to services or treatments thatpromote growth toward increased independence andcompetence. If the goal is to promote independence andcompetence, it is imperative that adult programs and servicesbe designed to facilitate skill development. Moreover, avariety of support services must be available to assist anindividual to live in a complex, heterogeneous society.

NORMALIZATION PRINCIPLE

Normalization refers to ". . . the utilization of asculturally-valued means as possible in order to establishand/or maintain personal behaviors, experiences andcharacteristics that are as culturally normative or valued aspossible" (Wolfensberger, 1980). This principle callsattention to (1) what the adult program achieves for thoseto whom it provides services (the "goals") and (2) how theprogram achieves these objectives (the means in thedefinition).

For example, work is a normal and expected activityfor most adults in our society; adults with developmentaldisabilities have a right to be contributing members ofsociety. They should have the opportunity to performpersonally_ rewarding work for competitive wages. A majorgoal of adult service programs should be to facilitate theinclusion of adults with developmental disabilities intofinancially rewarding work roles. Adult day programs shouldidentify and provide useful job opportunities, teach the skills,and provide the supports needed for successful performanceof these jobs. Employment training should be arranged toemulate, as much as possible, normal work situations andsettings.

9

Planning Principles

EQUAL JUSTICE

Adherence to the concept of equal justice requiresthat persons with developmental disabilities be provided withservices and supports that will allow them an equalopportunity for growth and development. Persons withdevelopmental disabilities should not be excluded from usinggeneric community resources or vocational programs.Generic resources are typical services provided by agenciesto the community at large. Providing only segregatedprograms and services is inconsistent with the person's rightto participate in normal community life. The principle ofequal justice requires that long-range plans be based on theassumption that all persons can and should participate asmuch as possible in all aspects of community lifeespeciallyin employment.

RESPECT FOR HUMAN DIGNITY

Most persons have personal characteristics andcompetencies that are valued by others, Also, they canadvocate for themselves and are therefore usually affordedat least a minimum of dignity and respect. Except in verylimited ways, persons with severe handicaps cannot gain thesame degree of dignity and respect by their own actions. Itis therefore extremely important that they be treated withrespect and served in settings that are positively valued.Adults with developmental disabilities should be treated asadults, not as children. Skill training should be provided asneeded, to increase their personal opportunities and enhancetheir financial independence.

DEV ELOPMENTAL ASSUMPTION

The developmental assumption is considered by mostpeople to be a desirable approach to serving nersons withdevelopmental disabilities and serves as & basis forappropriate service development. The developmentalassumption is based upon an acknowledgment of (1) life aschange (all individuals, regardless of type or degree ofhandicap, have the potential for positive growth) and (2)development as modifiable (influenced through teaching, andby using and controlling physical, psychological, and socialaspects of the environment).

For some time the prevalent view toward persons withdevelopmental disabilities has been the notion of limitedpotential, a belief that a disability causes or is necessarilyassociated with an inability to perform a variety of normalactivities such as communicating with others, taking care ofpersonal needs, living in the community and participating invocational opportunities. However, a number of research

3

3

Adult Programs

studies have shown that persons with developmentaldisabilities, even those with severe handicaps, can grow andlearn social and vocational skills (Bellamy et al., 1981;Bellamy, O'Connor, & karan, 1979; Gold, 1975, 1973; Levy,Pomerantz, & Gold, 1976; Martin, Rusch & Heal, 1982;

Pomerantz & Marholin, 1977).

EFFECTIVENESS AND ECONOMY

It is paradoxical that one of the most frequently citedreasons for many segregated programs, that they provideeffective and efficient ser' :ice and treatment, is notsupported by research findings (Pilewski & Heal, 1980;

McCarver & Craig, 1974). Recent research shows that itis very important, especially for persons with severe andprofound handicaps, to participate in training programs thatare as similar as possible to normal community settings(Martin, Rusch, & Heal, 1982). This is especially importantfor persons with mental retardation because of theirdifficulty in generalizing from the original learningenvironment to other settings.

The issue of cost strongly supports the development ofintegrated programs and work options for adults withdevelopmental disabilities. A productive and independentadult with developmental disabilities financially contributesmore to society than a person who is dependent upon societyfor his or her existence (Conley, 1973; General AccountingOffice, 1981; Moss, 1979). Although short-run costs may behigher to establish the necessary support services and

program options, the long-run cost to society is considerablyless. This is not to imply that all individuals are capableof total self-sufficiency. However, the technology exists tosubstantially increase the productivity and independence ofmost adults with developmental disabilities, including thosewith severe disabilities (Bellamy, Horner, 6( Inman, 19'i9;Rusch & Mithaug, 1980; Wehman, 1981). Moreover, someintegrated training options such as work stations in industryand on-the-job training programs, are less costly than thecapital costs involved in building new sheltered workshops

(Phipps, 1982).

The Community Services Subcommittee identified theOBJECTIVES OF objectives below for adult services programs. Based upon

ADULT PROGRAMS application of the basic planning principles previouslydescribed, adult service programs should:

4

o Place a priority on maximizing the person's financialindependence, through vocational skill development andproviding useful job opportunities

I4

Critical Analysis

o Promote social integration and movement of individualsinto more integrated vocational options such as on-the-job training programs, work stations in industry, andregular employment

o Provide valued jobs and training in settings that areage and culturally appropriate

o Use, as much as possible, physically and sociallyintegrated programs, training, an work options

o Promote the dignity of adults with developmentaldisabilities by treating them as workers/employees,developing their competencies to function successfullyin community life (at work, at home, and in leisuretime activities), and helping them participate in makingdecisions that affect their lives

Most states have either established a continuum ofCRITICAL ANALYSIS day program options for adults with developmental disabilitiesOF CURRENT PLANS or are planning for such programs. The continuum approach

is based on the assumption that different programs, usuallyin different settings, are necessary to meet a full range ofservice needs. A typical continuum of day program servicesis shown below.

Figure 1

DAY PROGRAM SERVICE CONTINUUM

Most socially integratedMost physically integrated

*WM

Least socially integratedLeas,. physically integrated

1'0

Regular employment

On-the-job training

Affirmative industry

Work station

Generic workshop

Sheltered workshop

Prevocational program

Activity center

Adult day care

No day program

5

6

Critical Analysis

DESCRIPTION

The continuum approach is based on the further assumptionthat persons with the most severe disabilities areappropriately served in more restrictive settings (adult daycare, activity centers); persons with the least severedisabilities are served in the most socially and physicallyintegrated settings (regular employment); and the remainingpersons are served in other settings across the continuumof service settings. The hope is that if the continuum iscomprehensive there will be no service "gaps"--all personswill be placed in an appropriate day program or employmentsetting. A brief description follows of the types of servicesand service settings commonly found on the adult day servicecontinuum:

o Regular Employment: a setting where the individualis working in a regular job with no continuing supportother than that any other worker typically receives

o On-the-job Training: a regular, nonsheltered worksetting where the individual receives support servicesand training

o Affirmative Industry: an industry that is operated toprovide supported employment, but is cost-benefit andproduction oriented (both disabled and nondisabledworkers are employed)

o Work Station in Industry: a small group of individualswith disabilities, working as a unit under specialsupervision, within a regular factory or work setting

o Generic Workshop: a sheltered workshop, such as thoseoperated by Goodwill, open to a wide range ofindividuals with various types and levels of disabilities

o Sheltered Workshop: a segregated workshop providingtraining and sheltered employment to individuals withsimilar disabilities (County Boards of MR/DD)

o Prevocational Program: a training program that focuseson teaching the prerequisite skills for future vocationaltraining

o Activity Center: a day activity program that providesa range of activities such as arts and crafts, dailyliving skills training and some prevocational orvocational training

o Adult Day Care: a day activity program that primarilyprovides day care and supervision, but little training

1.6

Critical Analysis

o No Day Program: no formal day program activities areprovided

NEGATIVE ASPECTS OF CONTINUUM

The development of such a comprehensive continuumoffers advantages over offering minimal day programservices. However, there are a number of problems withthe continuum approach.

Resources Go to Restrictive Settings

Most of the resources go to the more socially andphysically restrictive settings. Funds go first to provideadult day care, activity centers, and sheltered workshops.There has been a reliance on segregated day trainingprograms, many of which are ricit vocationally oriented. Veryfew resources are then left to support more integratPdivocational training and employment options. The resultinglack of resources has limited efforts to help persons moveout of segregated settings into more socially and physicallyintegrated options.

Movement Based on Improvement

Movement through the continuum is presumed to be afunction of improvements in the person's behavior. Theperson is seen as "graduating" from one program to another.There are many problems with this approach:

o Forced to Earn Rights: Persons with disabilities areforced to earn their right to participate irr,moreintegrated settings. Many persons, especially thosewith severe disabilities, will never "earn" this right.

o Little Movement: Studies have shown that there isnot much movement through the continuum to lessrestrictive, more valued work settings (Bellamy et al.1982; Department of Labor, 1977; GreenleighAssociates, Inc., 1975; Wilcox (Sc Bellamy, 1982).

o Individual is "Type Cast": The entrance and exitcriteria approach of the continuum strategy presumesthat individuals can be "type cast" adult day careclients, work activity center clients, or workshopclients. The continuum reinforces the notion thatcertain persons can be served only in certain types ofsettings and that certain programs and services can bedeveloped only in a specific setting.

17 7


Emphasis on Physical Facilities

The continuum approach has led to an emphasis on thedevelopment of physical facilities rather than on thedevelopment of comprehensive services that would allow anindividual to lead a more independent life in the community.

Reinforces Differences

The continuum approach reinforces and deepens theperception of difference between persons with disabilitiesand other, nondisabled, citizens. Separate day programsensure that disabled persons will not be integrated into themainstream of society.

Cost

Most of the settings currently in the service continuumare special facilities, which usually involve new constructionor extensive renovation of existing buildings. If service andtraining settings within existing business and industry areused, more public money could be reallocated to hire staffor provide support services.

Based on Availability

Adults with severe disabilities are often not served insheltered vocational programs because persons with lesssevere disabilities have already filled the available openings.If more integrated, work-oriented options are developed,workshops could then be used to serve individuals with severehandicaps.

Like other states, Ohio is attempting to implement

ADULT SERVICES portions of the continuum concept. A major emphasis is

IN OHIO on activity centers and workshops, established under theauspices of the County Boards of MR/DD. Private, nonprofitboards oversee the operation of these programs; therelationship between these boards and County Boards ofMR /DD varies from county to county. The major sourcesof support for adult service programs come from Departmentof MR/DD subsidies, county levies, and contract work.

8

Few resources have been available to support thedevelopment of more integrated s or training programs.Persons who are considered capable of some level ofemployment are placed in a workshop setting. Generally,persons who are considered unable to function in a wor (shopsetting are served in activity centers, which provide little,if any, real vocational training.

18


CRITICISMS OF DAY PROGRAMS

The program quality and level of vocational trainingprovided in adult day programs varies across the state.Criticisms of present day programs include the following:

o Generally, day programs do not adequately train adultsfor existing, useful work.

o Many individuals who are capable of functioning in lessrestrictive vocational options are maintained in activitycenters and workshop settings.

o Current day programs often provide insufficient wagesto promote financial independence.

o Habilitative and production staff often see themselvesas working at cross-purposes.

o Usually there is little movement of individuals to lessrestrictive work or training options.

o Maintenance of segregated programs inhibitsintegration into community life.

o A facilities-based, "segregated" approach has resultedin waiting lists for entry into programs.

o In many cases, there has been an emphasis on services(motor skills, socialization, communication, basiceducation, Special Olympics, recreation, arts and craftsactivities) rather than on vocational training andplacement.

o Dependence upon contract work has resulted insignificant periods of down time; other work activitieshave not been developed to supplement contract downtime.

MAJOR CONSTRAINTS

A variety of constraints at the federal, state, and locallevels have shaped the development of adult servicesprograms. Many of these constraints continue to affectefforts to plan for the deve'.opment of more appropriateoVions.

9

1.9

10


Federal Level

o The development of employment options in integratedsettings is not a major priority at the federal level.

o Supplemental Security Income (SSI) regulations limit theability of recipients to earn adequate wages and stillmaintain eligibility for ir,^ome and medical benefits.

o The Rehabilitation Services Program places emphasison services to the less severely handicapped andconsiders vork activities and sheltered employment ascase closures.

o Funds under the Vocational Education Program are notbeing used effectively to assist persons with severedisabilities.

o The Comprehensive Employment Training Act (CETA)program, which was developed to provide employmentopportunities in the private sector, was generally notused to assist persons with disabilities.

o Cuts in generic services have reduced the availabilityof support services and impeded the ability ofindividuals with disabilities to function in thecommunity.

State Level

o The state has no clear legislative mandate to plan forand to provide day program services to adults withdevelopmental disabilities.

o The state's funding mechanism for adult servicesprovides no incentive to move adults withdevelopmental disabilties into more socially andphysically integrated work and training options.

o Additional state funding has not ten available untilrecently to assist county programs in meeting the needsof persons moving from developmental centers backinto the community.

o The Department of MR/DD rule requiring that no fewerthan five hours per week per person be spent on definedhabilitative services encourages agencies to providehabilitative services in vocational settings, therebydecreasing the vocational thrust of the programs.

o Limited funding is available for staff development..

20

Whole Person Approach

o The relationship between vocational educationprograms, adult basic education programs,Rehabilitation Services Commission programs, andDepartment of MR/DD programs is not addressed instate level policies.

o The allocation of Rehabilitation Services Commissionfunds is inadequate to meet the needs of persons withdisabilities.

Local Level

o Adequate funds are not provided to support thedevelopment of more integrated training and workoptions, or for habilitative and recreational servicesfol adults (funding for support services, on-the-jobtraining, etc.).

o County Boards of MR/DD are perceived as responsiblefor providing "all services" to persons withdevelopmental disabilities. This prevents otheragencies, especially generic agencies, from becominginvolved.

o Transportation, especially in rural areas, is a majorbarrier to developing more integrated training and workopt ions.

o Many counties have been incapable of, or disinterestedin recruiting and training business-oriented personnelwith skills in such areas as production practices, fiscalmanagement, bidding, marketing, and labor relations.

o Some parents oppose more integrated training andemployment options because they value the perceivedsecurity of the existing segregated programs.

o There is reluctance to place persons in less restrictivesettings because of funding disincentives (impact onworkshop productivity, state subsidy program, etc.).

o Lack of community acceptance has restricted personswith developmental disabilities from participation incommunity life, especially in the area of employment.

o Personnel and funding resources are not provided toaddress the needs of persons with multiple handicapsor behavior problems.

If we are to meet the needs of adults with develop-WHOLE PERSON mental disabilities, communities must be prepared to offer

APPROACH the vocational training and work options, basic adult educa-tion and habilitation services, recreation programs,residential programs, and support services necessary to meet

2.1

11


the individual's total needs. These programs and servicesshould be provided in the most physically and sof:liallyintegrated settings and mariner possible, while still meetingthe individual's needs. The range of services, programs, andoptions that should comprise a community service system foradults with developmental disabilities is shown in figure 2.

Before discussing the various day program elements, it

FUNDAMENTAL is important to first describe three fundamental componentsPREREQUISITES of any service delivery strategy for adults with develop-

mental disabilities: utilization of generic services, casecoordination, and prevocational training.

GENERIC SERVICES

Although there has been a rapid development at thecommunity level of specialized services for adults withdevelopmental disabilities, there has also been a growingrealization that segregated, specialized programs are not themost appropriate way to meet their individual needs. Theutilization of generic services has become increasinglyimportant to the development of community-based servicesystems. If the goals for adults with developmentaldisabilities are to be realized, the accessibility and use ofgeneric services must be a major component of the plan forservice delivery. A listing of generic resources that areusually available at the local level is provided in figure 3.

The use of generic resources at the community levelis strongly supported by the previously discussed basicplanning principles. Persons with developmental disabilitieshave a right to participate in and benefit from these services;at the same time, access to generic services can be seenas indispensable in assuring the person's presence andparticipation as a valued member of the community.Moreover, dependence upon the "segregated services"provided by a single agency defeats the implied value ofcommunity life--the opportunity to live as others do in thecommunity. Because of the multiple needs of persons withsevere handicaps, it is not logical to assume that a singleagency or program can provide all of the services andsupports necessary for community life. Full services forpersons with severe handicaps will require a coordinated,multi-component system in which each service componentcomplements the other.

22

SUPPORT SERVICES

Case coordination/Follow-alongCounselingProtective servicesClient AdvocacyTransportationGeneric services-dental-medical-dietary/nutrition-pharmacy- prosthetic-chaplaincy-income assistance-social services

BASIC EDUCATION ANDSERVICES

PT/OT/PsychologicalDaily living skillsCommunication skillsBehavior managementMobilitySensory stimulation

st Social competencyConsumer educationSex educationPhysical developmentPrevocational education

Figure 2ADULT SERVICES

RESIDENTIAL(1)

(1)Residential services are discussed in Position Paper No. 2.

23

VOCATIONAL OPTIONS

Regular employmentOn-the-job trainingAffirmative industryWork stationGeneric workshop/vocational schoolsCBMR/DD workshopServices-vocational evaluation-work adjustment-occupational skill training-job placement-work service-follow-along-rehabilitation counseling-rehabilitation engineering

RECREATION/LEISURE TIMEGeneric recreationLeisure time alternativeCreative arts

24

Figure 3

LOCAL GL IERIC RESOURCES

HospitalClinics

Senior CitizensPrograms

Civic/FraternalOrganizations

ChurchesFamily Planning

Agencies

Public Defender/Legal Aid

Police/SheriffDepartment

Local HousingAgency

County WelfareDepart ment

ConsultingProfessionals

County HealthDepartment

Community HealthPrograms

Mental HealthPrograms

Private IndustryCouncils

Social SecurityOffice

Community SocialServices Agencies

14

AdvocacyPrograms

RecreationPrograms

TransportationAgencies

TradeUnions

Public Schools

BusinessAssociations

Adult EducationPrograms

Special Education\ Regional ResourceCenter

VocationalBureau Schools

EmploymentServices

EmploymentTrainingPrograms

RehabilitationServices

Commission

2

Fur iamental Prerequisites

In addition to the arguments provided above, there arepractical considerations that make continued dependence onsegregated programs unrealistic:

o Economic considerations argue against the continuedestablishment of segregated programs and services.

o Trained personnel are not available to staff thenecessary variety of segregated programs.

o Segregated programs and services contribute to thecontinued isolation of the MR/DD service system.

A comprehensive service system at the local level willnot develop without a concerted effort on the part of localagencies, especially by County Boards of MR/DD, to developeffective service delivery strategies. The guidelines providedin Appendix A and Appendix B may be useful in developingeffective service delivery strategies that include use ofgeneric service agencies.

CASE COORDINATION

The effectiveness of a multi-faceted delivery systemat the local level is predicated upon the ability to link theindividual to the various services that are available in thecommunity. If adults with developmental disabilities !Are tohave access to necessary supports and services, an effectivecase coordination system is needed at the local level. Theterm case coordination is used instead of the traditionalterm, case management, because it implies the linking ofcommunity resources rather than management of theindividual.

Presently there is no clearly designated agency orfunding mechanism solely responsible for case coordination.Case coordination is provided primarily by the state, CountyBoards of MR/DD, and service providers. In some cases itis provided formally (as a distinct service), and in othercases informally (as a part of a variety of other services).The development and coordination of linkages among avariety of providers requires significant effort. Such a taskbecomes very difficult when the burden falls on direct carestaff, or is only one of a variety of services offered by anagency. The lack of an effective case coordination systemis a major deficiency in Ohio's delivery system for adultservices.

15

26


Plans for adult services should include development ofa case coordination system at the local level that linksand coordinates segments of the service delivery system,ensuring the availability of a comprehensive array of servicesfor adults with developmental disabilities. A set of guidelinesthat may be used in developing a case coordination systemis in Appendix C.

PREVOCATIONAL TRAINING

A third fundamental component of a service deliverystrategy for adults is the availability of prevocationalprograms to prepare persons with developmental disabilitiesfor adult life. Skill training must begin early, during theschool-age years, to prepare persons to function effectivelyas adult workers. School-age programs (both County Boardof MR/DD and public school operated) must develop realisticprevocational programs to teach individuals the necessaryvocational skills. It is unrealistic to assume that such skillscan only be learned once the person "graduates" into anadult program. For persons with developmental disabilities,who generally acquire such skills over a long period of time,it is especially important to begin early.

As much as possible, prevocational training programsshould be provided in the community (in a real job setting),where such skills will be utilized not in artificial trainingsituations. Prevocational training programs shouldconcentrate on teaching functional vocational skillsskillsto do a specific job. Skill training for activities of dailylife should be part of the regular educational program and,whenever possible, not be provided as part of theprevocational program unless they are directly relatedthe person's ability to perform work or a specific job.Providing prevocational training in nonsheltered settingsallows for greater individualization and enhances thelikelihood of teaching useful job skills. Obviously, thenecessary supervision and supports must be provided to assistthe person in learning these skills in a community setting.

The development of effective prevocational trainingprograms requires a number of changes in the organizationand orientation of current programs:

o Prevocational programs must be sequenced with adultprograms.

o Prevocational training must be geared toward teachinguseful vocational skills necessary to do a specific job.

o Prevocational programs must be coordinated effectivelywith regular school programs.

16 27

Day Program Services

o Prevocational training should be provided in thecommunity as much as possible, not in a classroom.

o Personnel and financial resources should be flexible,to allow for providing prevocational training in thecommunity.

o Necessary supports, training, and supervision must bedeveloped to support such programs.

o Potential employers in the community (public, private,nonprofit) must be identified, recruited, and providedwith an understanding of the prevocational trainingthat will be provided to persons in the program.

o A linkage, such as a case coordination system, mustbe developed to ensure that individuals in schoolprograms are appropriately linked to adult programs.

Work serves many functions in society. It is a symbolDAY PROGRAM of normality and maturity; it is also a source of material and

SERVICES social gratification. Occupational status helps to define aperson's self-esteem and idsntity. Perceptions associatedwith the role of the worker underscore the importance ofdeveloping programs and services to assist adults withdevelopmental disabilities to prepare for, secure, and retainjobs as a part of living in the community. A strong emphasismust be placed on inclt"'ng persons with developmentaldisabilities in normative: d remunerative work roles.Persons with developmeno. uisubilities must perform usefulwork (jobs that are needed in some sector of the economy).Work is not defined as the process of one person putting anut on a bolt, then another person taking it off; nor is itdefined as making something that will never be purchased.Useful work is work that must be done, or someone else willhave to be paid to. do it.

ROLE OF DAY PROGRAMS

A major role of adult day programs must be to identifyor provide useful job opportunities, and to teach the skillsneeded for the successful performance of these jobs. Allindividuals with developmental disabilities, even persons withsevere disabilities, should be provided with the necessaryservices, supports, and training that will allow them toparticipate as much as possible in a vocational program. Anemphasis on vocational training and work options does notmean that persons with developmental disabilities do nothave other needs. Certainly, there is a need for an arrayof support services, habilitative services, basic adulteducation, and recreational programs. The absence of suchservices could re' trict the person's ability to live in the

17

Day Program Services

community or to participate effectively in vocational trainingand work options. The challenge that faces planners ofadult services is 'n finding ways to provide these otherservices without minimizing the vocational component.

FOCUS ON INDIVIDUAL NEEDS

Each adult with developmental disabilities should havean opportunity to spend a portion of the day in a vocationalsetting (workshop or, more preferably, nonshelteredvocational setting). The person's needs, as reflected in theIndividual Habilitation Plan (IHP), should determine theamount of time spent in a vocational setting versus timespent receiving habilitative or adult educational services.For example, a person with severe disabilities may spend agreater portion of the day receiving habilitation services,whereas a person with fewer needs may spend a greaterportion of the day receiving vocational services.

An example of how two persons with different needsmight have their time allocated is shown in figure 4. It isimportant to recognize that no person, regardless of severityof handicap, should be excluded from participation in avocational program. The concept of "vocational potential"should not be used to include or exclude individuals. Thefact that individuals with severe handicaps might spend (atleast initially) a significant amount of time in habilitativerather than vocational programs reflects their greater needfor habilitative services, not that placement in vocationaltraining i'las been determined to be inappropriate.

SETTINGS SEPARATE FROM VOCATIONAL

The principles of normalization and least restrictiveenvironment call for, as much as possible, use of genericservice providers and settings to provide an appropriatevariety and range of adult basic education and habilitationservices. Where this is not possible, such educationalservices should be provided in the most culturally normativeenvironment possible; adult basic education and habilitationservice programs should be separate from the vocationalsetting. Community colleges, adult education programssponsored by the public school system, or adult educationand habilitative service components within county programs,all could provide such services.

2918

Figure 4

EXAMPLE: PERCENTAGE OF TIME SPENT INTYPES OF PROGRAMS

SEVERELY HANDICAPPED

LESS SEVERELY HANDICAPPED

Individual I

Normal LifeActivities

43%

30

Individual II

Vocational33%

40°Recreation fOlk.

12% clMeatI

19

Vocational Options

Because of the difficulty a person with developmentaldisabilities often has in generalizing from the originallearning environment to other settings, community-relatedskills training should be provided, to the maximum extentpossible, in real life situations. For example, daily livingskills training should be provided where the individual lives,not in a classroom. If the residential program lacks resourcesto provide such training, the county program may have toprovide it (hopefully, where the person lives). Only as alast resort should a simulated setting be used within theadult education/habilitative service unit.

Historically, activity centers and workshops have

VOCATIONAL OPTIONS been the primary environments in which vocational train-IN THE COMMUNITY ing, employment, and other services to adults with develop-

mental disabilities were provided (Bellamy et al., 1982).Many of the criticisms of this approach have been discussedpreviously in this paper (failure to train individuals for realjobs, downtime, waiting list, continued segregation, tolerancefor deviance, little movement out, insufficient wages). Fewresources have been used effectively to develop more sociallyand physically integrated vocational options. If our goalsfor adult service programs are to be realized, a concertedeffort must be made to develop appropriate, nonshelteredvocational training and work options such as work stationsin industry (McGee, 1975), on-the-job training programs,projects with industry (Jewish Vocational Services, 1978),and regular employment (Wehman, 1981). It is important tonote that as the number of normativeenvironments within which a person can function is increased,personal freedom, opportunities for development, and humandignity are also increased.

Moreover, the development of a variety of vocationaloptions in the community provides a greater opportunity forindividualizing the service setting. The individual can bematched to environments best suited to meet his or herneeds and ability to function. Demonstration projects haveillustrated that many adults with developmental disabilities,given the necessary supports and services, can functioneffectively in nonsheltered vocational environments in thecommunity (Cook, Dahl, Sc Gale, 1977; Rusch & Mithaug,1980; Sowers, Thompson, & Connis, 1979; Wehman, 1981).This does not mean that it will be possible to support alladults with developmental disabilities in nonshelteredsettings. Certainly, it may not be possible to provide theextensive services necessary to support severely handicappedindividuals in nonsheltered settings. However, manyindividuals currently served in our present adult programscould be supported in less restrictive settings.

20 31

Workshops

The development of less restrictive options necessitatesthe following fundamental changes in services to adults withdevelopmental disbilities:

o The necessary supports, services, and innovativeprogram models (on-the-job training, work stations,projects with industry) must be developed to assistindividuals in functioning within communityenvironments.

o School-age programs must interfa.?e with adult programsto ensure that individuals are provided with theprerequisite skills necessary to function in adultprogram environments.

o Funding mechanisms must be flexible to support andencourage such efforts.

o Education and preparation programs must be developedfor employers to increase their willingness to hirecompetent, well-trained persons with developmentaldisabilities and to provide a normal, supportive,tolerant, and stable work setting.

o Parent education programs and mechanisms must bedeveloped to allow for parent preferences and input.

o More personnel must be trained to place, train, andsupport individuals functioning in nonshelteredenvironments.

o Job markets must be analyzed in each comm unity toidentify available jobs that lend themselves to currenttraining technology.

Some type of sheltered setting will he neededeither inWORKSHOPS a generic agency or in a County Board MR/DD program

for individuals with more severe handicaps who are not beingserved in a nonsheltered vocational option in the community.Generic workshops that serve nondevelcpmentally disabledindividuals, such as the affirmative industry model programs(DuRand & DuRand, 1978), or vocational training schools,could be used to provide vocational training and employment.Where these options are not available or appropriate, CountyBoard of MR/DD workshops will need to provide thevocational training and employment services for adults withdevelopmental disabilities. The role of the workshop shouldbe threefold: (1) to provide the vocational skills trainingnecessary to perform useful work (2) to prepare individualsfor vocational options in the community and (3) to providereal jobs for adequate wages.

3221

Workshops

National studies document a variety of problems withworkshop programs (Breedlove & Johnson, 1981; GeneralAccounting Office, 1980; Greenleigh, 1975; U.S. Departmentof Labor, 1977, 1979). These studies provide detaileddescriptions of the practices and outcomes of shelteredworkshops, namely, atypical work environments, poor wages,inefficient end outdated production design, downtime, littlemovement to more integrated vocational options, lack ofwork or training that is relevant to actual jobs, and staffwho are not well-versed in industry practices.

Also, as workshops have assumed responsibility for thevocational and many other service aspects of a person's life,their power and control over the person has grown.Certainly, the wisdom of turning persons with disabilitiesinto "eternal clients" of a single agency is unacceptable.

For workshop programs to provide useful jobs, adequatewages, and effective vocational training, they must becomemore business oriented. Persons functioning in such a settingshould be treated as employees and workers, not as clientsor pupils. The presumption should be that all individuals,even those with severe disabilities, should spend a portionof their day performing useful work and/or receivingvocational skill training. Habilitative and adult basiceducation services should be provided outside the workshopsetting.

The development of more appropriate vocational optionsnecessitates the following fundamental changes in workshopprograms for adults with developmental disabilities:

o Generic workshops and vocational schools must be usedwhenever appropriate.

o Real jobs, providing fair wages and benefits, must bedeveloped in workshop programs.

o Realistic work environments must be created.

o k range of job choices must be created in workshopprograms.

o Proven vocational training technologies must be used.

o A business orientation must be developed by using stateof the art technology in management, contractdevelopment, production design, job design, personnelrelations, capital investments, and marketing practices.

o Service delivery strategies that do not decrease thevocational aspect of the program must be developedfor nonvocational services.

22

Traditional vs. Proposed

o Experienced individuals, especially those with abusiness orientation, must be employed. Communitybusiness representatives must be found to serve onworkshop boards.

o The ability of the workshop must be enhanced toprovide "real work", such as through projects withindustry.

There are many differences between the way vocationalTRADITIONAL services have traditionally been provided to persons with dis-

VS. abilities and the approach being proposed in this paper. ThePROPOSED following examples illustrate how those di:'ferences might

APPROACHES apply to persons with different levels and types of disabi-lities.

PERSON WITH SEVERE DISABILITIES

Joan is labeled as being severely/profoundlymentally retarded; she also has cerebral palsy.Because of her cerebral palsy, she must use awheelchair, and only has limited movement anduse of her arms and hands. Her speech is notunderstandable, but she is learning to use acommunication board.

Traditional Approach

Because of her severe disabilities, Joan was not placedin a work program, or even in a vocational training program.Her day program consisted of participation in a variety ofactivities such as physical therapy exercises, crafts andgames, training in activities of daily living, and communitytrips. Her day program took place in a separate day-activitycenter.

The day program was not a full day program; it startedaround 9 a.m. and finished by 2 p.m. Joan was bused to acentral day-activity center, further reducing her actualprogram time.

Most of the other clients who attended the programwith Joan were also labeled as severely disabled.

The activity program was perceived, at least by staff,as a final placement for Joan. It was hoped that she wouldprogress in the program, but she would never leave it; theprogram was considered appropriate for her.

3423

24


Proposed Approach

Even though Joan was labeled as having severedisabilities, she was not denied access to a work or vocationaltraining program. Through comprehensive evaluations, theprogram was designed to be truly habilitative and not justa series of unrelated day activities. Joan's current majorneeds were in the education/habilitation area so she spentmost of her day in such programs.

Even though Joan's major needs were habilitative, shewas still enrolled in some type of appropriate work orvocational program. At first, she spent only a day or evena half-day each week in the vocational program, but shewas never labeled as having "no vocational potential" andforever relegated to games and crafts. A major effort wasmade to maximize Joan's contact with persons who were not.,:isabled and/or had less severe disabilities. Her habilitativeprogram was located in a facility that provided a wide rangeof educational and habilitative services to a variety ofpersons, not just to those with the most severe disabilities.

Joan's current placement situation was not consideredpermanent. The staff expected and planned for her graduallyto spend more and more of her day program time in avocational setting. Staff also took a major responsibilityfor supporting this move, through special efforts such asequipment adaptation and development of prosthetics. Theentire responsibility for acquiring new skills andcompetencies was not placed on Joan.

PERSON WITH MODERATE DISABILITIES

Jerry is twenty years old and has been labeledmoderately mentally retarded. He does not haveany physical disabilities, but does have a seriousspeech impediment. He is learning to sign, alongwith speaking, so that he can communicate moreeffectively. Jerry recently graduated from aCounty Board of MR/DD school program and nowis interested in getting a job.

Traditional Approach

Even though Jerry graduated from his County Boardof MR/DD school program, he was not judged as being readyfor job placement. During the last two years of his schoolprogram, he was enrolled in a prevocational program, butwas not taught the skills necessary to be placed in acompetitive employment position. Most of Jerry'sprevocational training program focused on general "readiness"skills and did not prepare him with specific job competencies.

3J


Jerry was first placed at Level I in a shelteredworkshop. His Level I program provided a wide variety ofactivities:

o Training in daily living skills

o Recreational and leisure time activities

o Basic academic skill training

The vocational part of his program involved working on apackaging and boxing contract. The evaluation teamidentified five major skill deficit areas that needed to beremediated before Jerry could be placed on the job placementwaiting list.

Proposed Approach

During the last ten years of Jerry's school program,he was increasingly involved in a functionally orientedvocational training program. His junior high program focusedon functional prevocational skill training in work settingsoutside of the school. In high school, the emphasis shiftedto specific job training. The job training activities werebased on Jerry's skills and interests and were provided innormal, nonsheltered work settings.

The evaluation team's initial recommendation was thatJerry should be enrolled in the job placement program.However, because of the long waiting list for job placement,he initially worked in a work station in industry. Jerry andsix other persons worked under special supervision on a smallengine assembly line in a local factory.

As soon as a position became available in the placementprogram, staff began the search for an appropriate job forJerry. The proposed plan was:

o To evaluate Jerry's skills and job preferences (train;ng-based evaluation)

o To find an appropriate job situation

o To provide an on-the-job training program

o To design a special support and supervision strategy

o To develop a plan for gradual withdrawal of specialsupports and establish a strategy for follow-up and jobmaintenance

The adult program staff did not ignore Jerry's otherday program needs. He was interested in increasing hisskills in areas such as money management, reading, writing,

36 25

Special Needs

and sign communication. Jerry enrolled in a special adultbasic skills program jointly offered at night and on weekendsby the service progvam and the community college.

Jerry's recreational and leisure program involved awide variety of activities offered by his day program agencyand by the local community recreation program.

To be truly comprehensive, an adult services programPERSONS WITH must be able to serve persons with sp cial needs such as:

SPECIAL NEEDS

26

o Persons with severe behavior problems

o Persons with multiple handicap.

o Older persons

Until appropriate, community-based residential and dayprograms are developed, most of these persons will be forcedto remain in state-operated developmental centers or inrestrictive, community residential programs.

PERSONS WITH MULTIPLE HANDICAPS

Persons with profound and multiple handicaps are notusually considered to have "vocational potential," and areoften relegated to basic habilitation or activity programs.However, as noted earlier, all adults, regardless of severityof handicap, have a right to at least some participation ina vocational program. Given that most individuals withmultiple handicaps have other more pressing needs (learningto eat, walk, self-care, etc.), they should spend more oftheir program time involved in basic education andhabilitation programs. However, they should never be totallyexcluded from a vocational program and should spend asmuch time as possible, given their other service needs,involved in vocational training.

PERSONS WITH SEVERE BEHAVIOR PROBLEMS

Persons with severe behavior problems are difficult toserve for reasons that differ from those affecting personswith other types of developmental disabilities. Many personshave all the requisite skills and could function in a vocationalsetting except for the presence of competing, severe behaviorproblems.

By applyirkg the same service principles as describedpreviously, we should attempt to train such persons in thesame settings as those used for other individuals. Specializedsupport services such as behavior management teams couldbe used to help regular staff meet the person's needs withoutremoving them from the regular work or training environment.

Special Needs

Most behavior problems can be effectively dealt with throughbetter tra;ned staff and additional, temporary, support staff.

It will not be possible, at least initially, to placeindividuals with the most severe problems in regular ortypical programs. The regular setting is best for meetingtheir needsit is almost always better to train or teach inthe performance setting. However, an individual with severeproblems might seriously disrupt the work or training settingfor everyone else. Therefore, it will be necessary to developa few specialised work/training programs. Such programsshould:

o Be as realistic and normative as possible (preferably,in the regular site)

o Serve as few individuals as possible, for as short atime as possible

o Try to provide for more appropriate role models (noteveryone in the special program should have severebehavior problems)

o Allow for a gradual transition, with follow-up, backinto the regular work environment

o Be administratively integrated with the typical workor training program.

OLDER PERSONS

As they grow older, most people gradually change howthey spend their day. It is only natural that similar changesshould occur for older persons with developmentaldisabilities. This is a time when older persons withdevelopmental disabilities are in double jeopardythe stigmaand devaluation shown toward older citizens is added toproblems already related to their developmental disability.It is clear that in most communities, day programs andservices for older citizens are inadequate to meet the needand, further, that older persons with developmentaldisabilities are often denied access to even these minimalservices.

Many of the community services that are needed byolder persons with developmental disabilities are for supportin their living situation (see Position Paper No. 2). However,other services, such as recreation and leisure time programs,case coordination, counseling services, and transportationare also necessary to meet a full range of needs. Thechallenge is to work toward the integration of older personswith developmental disabilities into the typical genericservices available to all older citizens (programs sponsoredby local agencies for the elderly).

3827

28

Special Needs

At the state level. efforts to establish linkages withthe Ohio Commission on Aging will be a first step indeveloping such relationships. Where adequate genericservices are not available, it may be necessary for MR/DDservice agencies to assist in the development of the necessaryservices. For instance, if a generic recreational and craft-oriented day program is not available, it might be necessaryfor the developmental disability program to help developsuch a service. However, instead of developing a programto serve only older persons with developmental disabilities,the service could also be made available to older citizenswithout developmental disabilities and thereby provide a moreintegrated, less restrictive alternative.

Programmatic solutions for many of the problems ofolder citizens with developmental disabilities have yet to bedeveloped. The elderly have long played an "invisible role."A major step forward will be to begin gathering systematicdata on needs, and to provide a specific focus in our long-term planning for older persons.

CURRENTLY UNSERVED PERSONS

One frequently identified problem concerns theavailability of adult services for persons with mildretardation, or developmental disabilities other than mentalretardation. Many such persons who may be in need ofassistance are presently not receiving the services they needto participate effectively in community life, due to eligibilityrequirements, funding constraints, or lack of designation ofthe responsible agency for providing services. Presently, noagency is clearly designated as responsible for ensuring thatneeds of this group are met. This problem is complicatedby the fact that insufficient data exist on the number ofpersons involved or the types of services needed.

In an effort to address, at least partly, the problemof availability of services for persons with mild mentalretardation or developmental disabilities other than mentalretardation, this raper calls for a concerted effort on thepart of the major state agencies and consumer groups to:

o Identify the type and number of persons in need ofservice

o Identify the types of services needed

o Identify the appropriate services presently available

o Develop cost estimates for providing the neededservices

3)

RECOMMENDATIONS

Recommendations

o Develop strategies for ensuring that needs are met

Funding for this study could be obtained throughrequests to various state agencies and to the DevelopmentalDisabilities Planning Council.

GENERAL

o Vocational training and work options should exist inthe community (in local business and industry) forpersons with developmental disabilities. An array ofsupports, services, and training options will be requiredto assist individuals to function in such settings.

o Workshop programs should exist that provide a realisticwork environment, valued jobs, skills training, andadequate wages and benefits.

o Public education and training programs that supportthe movement of persons with developmental disabilitiesinto community training and work options should existfor parents and potential employers.

o Realistic prevocational training programs should existin school programs and be sequenced with adult servicesprograms.

o Habilitative and adult basic education programs,separate from the vocational environment, should existfor persons with developmental disabilities.

o Vocational options for persons with severe/multiplehandicaps or behavior problems should be available atthe local level.

o Skill training in daily living should exist and be provided(to the extent possible) in the community where thoseskills will be utilized.

o State of the art technology in business practices suchas production control, management, contractdevelopment, capital investment, marketing, andpersonnel relations, etc. should be used in duvelopingand operating vocational programs.

o An empowered case coordination system should existin each county or multi-county area of the state.

o Joint policy statements/agreements should exist amonglocal agencies relative to providing and funding servicesfor persons with developmental disabilities.

029

Recommendations

o A clear legislative mandate should exist that delineatesthe responsible agent(s) for planning and deliveringservices to adults with developmental disabilities.

o A statewide policy should exist that delineates therelationship among the following programs for servicesto persons with developmental disabilities: VocationalEducation, Adult Basic Education, RehabilitationServices Commission, Commission on Aging, Departmentof MR/DD, and County Boards of MR/DD.

o A study should be conducted to determine the numberand service needs of mildly retarded and nonmentallyretarded adults with developmental disabilities.Strategies should be developed for meeting the needsidentified.

o An administrative rule should exist that clearlydelineates responsibilities of County Boards of MR/DDfor adult services, under the provisions of AmendedSubstitute Senate Bill 160.

PLANNING

o Planning for adult services should be an integralcomponent of a community's comprehensive plan forservices to persons with developmental disabilities.

o There should be broad-based community involvement inthe planning and development of adult services.

o A community's comprehensive plan should include anassessment of the generic services available in thecommunity and strategies for increasing the use of suchservices by persons with developmental disabilities.

o A community's comprehensive plan should includestrategies for developing vocational training and workoptions in the community such as on-the-job training,regular employment options, work stations in industry,etc.

o A community's comprehensive plan should includestrategies for developing prevocational trainingprograms, particularly those that provide realistic jobtraining in the community.

o A statewide plan should exist to increase adult servicesfor persons with developmental disabilities.

30 41

Recommendations

FUNDING

o An equitable funding base should exist to support theprovision of services to adults with developmentaldisabilities.

o Equitable financial assistance should be provided toCounty Boards of MR/DD for persons being plaead fromdevelopmental centers into community programs.

o Funding mechanisms for adult services programs shouldprovide inc.:" rives to move adults with developmental

Ant., more socially and physically integratedwork and training options.

o Reasonable funding should be allocated for staffdevelopment and training programs.

MONITORING/EVALUATION

o Minimum standards and criteria should address qualityof life and normalization orinciples in the ruler andmonitoring/evaluation processes for adult servicesPrograms.

o A formal statewide process should exist tomonitor/evaluate adult services programs for personswith developmental disabilities.

o ACMR/DD and/or Commission on Accreditation ofRehabilitation Facilities (CARE) standards should beused in developing rules governing adult servicesprograms for persons with developmental disabilities.

TRAINING AND TECHNICAL ASSISTANCE

o Staff development programs should exist to erasure theavailability of trained adult services personnel.

o Technical assistance and consultation should be madeavailable to assist in planning, developing. andoperating adult services programs for persons withdevelopmental disabilities.

42 31

References

Bellamy, G.T., Horner, R.H., & Inman, D.P. (1979). Vocational habilitation of severelyretarded adults: A direct service technology. Baltimore: University Park Press.

Bellamy, G.T., Horner, R.H., Sheeban, M.R., & Bolls, S.M. (1981). Structured employmentand workshop reform: Equal rights for severely handicapped individuals. In J.I,apadakis, J. Ansley, & J. Lowitt (Eds.), Work, services and change: Proceedingsfrom the National Institute on Rehabilitation Facilities. Washington, DC: N.A.R.F.

Bellamy, G.T., O'Connor, G., & Karan, O.C. (Eds.). (1979). Vocational rehabilitationof severely handicapped persons: Contemporary service strategies. Baltimore:University Park Press.

Bellamy, G.T., Rhodes, L.E., Boubeau, P.E., & Mank, D. (March, 1982). Mental retardationservices in sheltered workshops and day activity programs: Consumer outcomes andpolicy alternatives. .'aper presented at the National Working Conference onVocational Services and Employment Opportunities. Madison, WI.

Breedlove, L. & Johnson, T. (1981). A report of the assessment of vocational educationalternatives by means of program analysis of service systems (PASS). Madison, WI.

Conley, R.W. (1973). The economics of mental retardation. Baltimore: Johns HopkinsUniversity Press.

Cook, P. Dahl, P., & Gale, M. (1977). Vocational training & placement of severelyhandicapped: Vocational opportunities. Palo Alto. The American Institute forResearch in the Behavioral Sciences.

Durand, J. & Durand, L. (1978). The affirmative industry. St. Paul: MinnesotaDiversified Industries.

General Accounting Office. (1981). Stronger federal efforts needed for providingemployment opportunities and enforcing labor standards in sheltered workshops(Comptroller General's report to the Honorable Barry M. Goldwater, Jr.).Washington, DC: Author.

General Accounting Office. (1980). Better reevaluation of handicapped persons insheltered workshops could increase their opportunities for competitive employment.Washington, DC: Author.

Gold, M.W. (1975). Vocational training. In J. Wortis (Ed.), Mental retardation anddevelopmental disabilities: An annual review, 7. New York: Brunner/Mazel.

Gold, M.W. (1973). Research on the vocational habilitation of the mentally retarded:The present and the future. In N.R. Ellis (Ed.), International review of researchin mental retardation, 6. New York: Academic Press.

Greenleigh Associates, Inc. (1975). The role of the sheltered workshop in therehabilitation of the severely handicapped (Report to the Department of HEW,Rehabilitation Services Administration), New York: Author.

Jewish Vocational Service. (1978). Program models for projects with industry. Chicago:Author.

43 33

References

Levy, S.M., Pomerantz, D.M., & Gold, M.W. (1976). Work skill development. In N.G.Haring & L. Brown (Eds.), Teaching the severely handicapped: A yearly publicationof tht. American Association for the Education of the Severely/ProfoundlyHandicapped, 1. New York: Grune & Stratton.

Martin, J.E., Rusch, F.R., & Heal, L.W. (1982). Teaching community survival skills tomentally retarded adults: A review and analysis. The Journal of Special Education,16(3), 243-267.

McGee, J. (1975). Work stations in industry. Lawrence, KS: University of Kansas,Kansas University Affiliated Facility.

Moss, J.W. (1979). Post-secondary vocational education for mentally retarded adults.(Final report to the Division of Developmental Disabilities, Rehabilitation ServicesAdministration, Dept. of HEW, 56P-50281/o). Washington DC : Author.

Phipps, C. et al. (1982). Job development, training & placement project. Columbus:Franklin County Board of Mental Retardation & Developmental Disabilities.Unpublished manuscript.

Pomerantz, 0. & Marholin, D. (1977). Vocational habilitation: A time for change. InE. Sontag (Ed.), Educational programming for the severely and profoundlyhandicapped. Reston, VA: Council for Exceptional Children.

Rusch, F. & Mitgaug, D. (1980). Vocational training for mentally retarded adults: A

behavior analytic approach. Champaign, IL: Research Press.

Sowers, J., Thompson, L., & Connis, R. (1979). The food service vocational trainingprogram. In G.T. Bellamy, G. O'Connor, & 0. Karan (Eds.), Vocational rehabilitationof severely handicapped persons: Contemporary service strategies. Baltimore:University Park Press.

U.S. Dept. of Labor. (1979). Study of handicapped clients in sheltered workshops, II.Washington, DC : Author.

U.S. Dept. of Labor. (1977). Sheltered workshop study: A nationwide report onsheltered workshops and their em lo ment of handicased individuals. Washington,DC: Author.

Wehtnan, P. (1981). Competitive employment: New horizons for severely disabledindividuals. Baltimore: P.H. Brooks.

Wilcox, B. & Bellamy, G. (1982). Design of high school programs for severelyhandicapped students. Baltimore: P.H. Brooks.

Wolfensberger, W. (1980). The definition of normalization: Update, problems,disagreements and misunderstandings. In R.J. Flynn, & L.E. Nitsch (Eds.),Normalization, social integration and community services. Baltimore: UniversityPark Press.

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Appendix A

GUIDELINES TO FACILITATE USE OFCOMMUNITY GENERIC RESOURCES

1. MR/DD agencies should attempt to use existingcommunity services rather than develop new servicesor compete with generic agencies for limited funds.

2. Shared service agreements may be developed betweenMR/DD agencies and generic service providers as ameans to expand limited community resources.

3. Existing MR/DD service and advocacy agencies have aresponsibilty to educate and train the public, and otheragencies, in how to war c with individuals withdevelopmental disabilities.

4. An individual's right to confidentiality should berespected, but it should not prevent effective servicedelivery strategies or cooperative efforts amongagencies for the benefit of the individual. Properinformation release forms should be developed and used.

5. When possible, MR/DD and other community serviceagencies should explore the feasibility of jointarrangements for support services to use communityresources more effectively. One such arrangement isjoint purchasing.

6. Efforts at problem solving in human service deliveryshould first be initiated among the agencies involvedat the local level.

7. MR/DD agencies should erk.tourage and participate incommunity structures that promote local planning,coordination, and problem solving in human servicedeliv ery.

8. Interagency agreements, parallel procedures, designatedstaff liaisons, local information and referral networks,and mediation models should be explored as means topromote community linkages. Some recommendedelements to be considered in developing localinteragency agreements are in Appendix B.

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Appendix B

RECOMMENDED ELEMENTS TO BE INCLUDED INAGRhEMENTS WITH OTHER AGENCIES

Statement of Purpose

One of the first items included should be a statementof purpose for the agreement. It should include a delineationof goals and measurable objectives for the term of theagreement. The writing of objectives in measurable unitswill greatly facilitate later evaluation of the success of anagreement.

Definition of Terms

Many times the terminology used by one agency isfamiliar only to that agency. Evaluatior may mean onething to a health agency, but have a different meaning toeducators. It is essential to define any ambiguous orunfamiliar terms.

Program Delineation

There ,should be a clear delineation of the specificprogram, service, or focus for which the document is beingwrittei. Such statements do not need to be long, drawn-out descriptions written in .ninute detail, but should includeenough information that the reader can easily understandthe program being described.

First Dollar Responsibility

The agreement needs to specify the agency that hasfirst dollar responsibility for payment of services. Thespecification of other financial or funding arrangements forpayment of services also should be addressed.

Roles and Responsibilities

The specific actions, roles, and responsibilities of eachparty to an agreement should be written clearly so there isno confusion as to who does what, when, and where. Atthe saw, time, mutual responsibilities need to be set forth.

SOURCE: Modified version of Smith, C.B., (1978).Interagency agreements as a mechanism forcoordination. Columbus, OH: Ohio StateUniversity. Unpublished manuscript.

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Appendix B

Designation of Responsible Positions

The major fault of many agreements between agenciesis failure to assign specific responsibility for ensuring thatthe provisions of the agreement are carried out. Toa manytimes an agreement will be written, filed away, andforgotten, until a major crisis or problem comes along. Toprevent this from occurring, the terms of the agreementshould specify a staff position from each agency that isparty to the agreement. Persons in the designated staffpositions assume responsibility for:

o Implementing the agreement as specified

o Monitoring the implementation to ensure its success

o Negotiating changes in the agreement

Administrative Procedure

Numerous general administrative procedures need to bea part of every agreement. These include a specified startingand ending date for the agreement; a mechanism forreviewing, updating, and revising it; confidentialitysafeguards; referral mechanisms; and procedures forinformation sharing.

Assurances

Agencies, particularly those receiving federal and statefunds, are required to meet certain standards orrequirements. It is important to specify under the agreementany requirements that must be met, and include any necessaryassurances.

Arbitration/Termination Clause

Misunderstandings and disputes between agencies areinevitable. A formal process to arbitrate such disputes isan important element to include in any agreement. Inaddition, specific procedures for the termination of theagreement should be included.

Evaluation Des lign

To assist in determining the success or failure of aninteragency agreement, it is extremely helpful to build anevaluation mechanism into the agreement itself. The designof this mechanism should be specified, and agreed upon byall parties. The person(s) responsible for the evaluationshould be identified in the agreement, and sanctions to ensureimplementation should be specified.

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Appendix C

Guidelines for the Development of aCase Coordination System

1. An empowered Community Case Coordination Systemshould be developed in each county or multi-countyarea in Ohio.

2. The Community Case Coordination System shouldprovide a fixed point of responsibility at the locallevel. The coordinator will attempt to ensure that aperson's needs are identified and met, through thedevelopment of that person's Individual HabilitationPlan (IHP) and by linking the person with appropriateservice providers.

3. The target population for a Community CaseCoordination System should be all persons who meetthe present federal definition of developmentaldisabilities.

4. The major functions of a Community Case CoordinationSystem should be:

o Outreach, screening, entry, intake or admissiono Referralo Problem assessmento IHP development and implementationo Follow-up and follow-along

5. The Community Case Coordination System should trainand support families and consumers to identify andaccess appropriate community services.

6. The Community Case Coordination System should usepresently available technology to develop anappropriate data base for the service system.

7. The Community Case Coordination System should haveprime responsibility for ensuring that the person's IHPis jointly developed by all relevant persons andagencies.

8. Ultimate responsibility for Community CaseCoordination should reside with the countycommissioners. The county commissioners may delegatethe function to an appropriate public or nonprofitcommunity agency, or establish an independent agency.

9. If the community case coordination function isdelegated to an agency providing direct service,community case coordination should be organizationallyand functionally separated from service provision.

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DEINSTITUTIONALIZATION TASK FORCE MEMBERS

Henry Leland, Co-chairpersonChief of PsychologyNisonger CenterThe Ohio State University1.580 Cannon DriveColumbus, Ohio 43210

William Gilbert, Co-chairpersonAdministrator, Psychological ServicesOhio Department of Rehabilitation

and CorrectionsSuite 4121050 Freeway DriveColumbus, Ohio 43229

Dorothy ReynoldsExecutive Vice PresidentFranklin County Mental Health Board447 East Broad StreetColumbus, Ohio 43215

Kate HallerLegal Counsel to the DirectorOhio Department of Mental Health30 East Broad StreetColumbus, Ohio 43215

Roger GoyaPsychiatrist235 Old Village RoadColumbus, Ohio 43228

Nick Wary IlkOhio Association for Retarded Citizens751 Northwest BoulevardColumbus,, Ohio 43212

Wade HitsingExecutive DirectorOhio Society for Autistic Citizens751 Northwest BoulevardColumbus, Ohio 43212

Anita BartonOhio Private Residental Association36 West Gay StreetColumbus, Ohio 43215

Denis StoddardExecutive DirectorOhio DD Planning Council30 East Broad StreetColumbus, Ohio 43215

Bruee MobleyChief, Office of PlanningOhio Department of MR/DD30 East Broad StreetColumbus, Ohio 43215

Alvin HadleyDirector, Division for Services to

Families and ChildrenFranklin County Children Services1951 Gantz ReadGrove City, Ohio 43123

Cheryl PhippsAssistant SuperintendentFranklin County Board of MR/DD2879 Johnstown RoadColumbus, Ohio 43219

COMMUNITY SERVICES SUBCOMMITTEEDEIESTITUTIONALIZATION TASK FORCE

Elsh, Helsel, Chairperson188 Longview HeightsAthens, Ohio 45701

Martin Edger/Southwe0 Community Health

Centers, Inc.199 South Central AvenueColumbus, Ohio 43223

Henry LelandNisonger CenterThe Ohio State University1580 Cannon DriveColumbus, Ohio 43210

Chris LohrmanBuckeye Community Services139 Pearl StreetP.O. Box 604Jackson, Ohio 45640

Joe CozzolinoHuman Services Collaborative653 South High StreetColumbus, Ohio 43206

Rick MarriottRoss County Board of MR/DD11268 County Road 550Chillicothe, Ohio 45601

Sue MillerOhio kssociation for Retarded Citizens751 Northwest BoulevardColumbus, Ohio 43212

Ann LawyerOhio Society for Autistic Citizens1814 Roxbury RoadColumbus, Ohio 43212

Robert KraussFranklin County Board of MR/DD2879 Johnstown RoadColumbus, Ohio 43219

Carolyn KnightOhio Legal Rights Service8 East Long StreetColumbus, Ohio 43215

Jerry AdamsOhio DD Planning Council30 East Broad StreetColumbus, Ohio 43215

Rita BennetCentral Ohio Rehabilitation Center1331 Edgehill RoadColumbus, Ohio 43212

Haney McAvoyOhio Department of AR/DD30 East Broad StreetColumbus, Ohio 43205

Wade HitzingOhio Society for .autistic Citizens751 Northwest BoulevardColumbus, Ohio 43212

Agency affiliations are provided for informational purposes only and do not necessarily implythat the respective organizations have endorsed the contents of this paper.

DOCUMENT RESUME - ERIC · DOCUMENT RESUME ED 250 899 EC 171 137 AUTHOR Kozlowski, Ronald E.; And...

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