Reminiscence of a program writer

Assessments used on individuals with developmental disabilities may vary in formats but many of them ask the same
questions in an attempt to identify deficits and strengths in the individual's ability to lead a normal life independently.  
When assessing an individual with disabilities the evaluation should encompass all aspects of life as it relates to
community living which include:
A.  Activities of daily living:  Which include all the processes and skills that are required to lead a healthy, safe and
normal life.  This is a large section of the assessment process that evaluates one's daily life routines- from the time they
wake up each day until the time they retire for bed and everything in between.  An individual may be deficient in this area
either due to lack of skills, inability to attain these skills, physical limitations or all the above.

B.  Behavior:  Behavioral issues that prevent a person from living in a community are another important part of the
assessment that evaluates social and coping skills. Inappropriate behaviors may be the result of certain mental disorders
that are normally diagnosed, monitored and treated by a psychiatrist.  Or they can be learned behaviors that give some sort
of mental or physical reward to the individual which has to be dealt with through formal or informal behavior modification.  

One does not have to master all activities of daily living in order to be a productive and functioning citizen in his society.  
For instance, making bed may not be as important as having a clean bed.  Or showering every 3rd day maybe acceptable at
some jobs while not combing your hair daily at the same job is unacceptable.

Behavioral issues have similar limitations.  Reclusive preferences, overly friendly attitudes and overbearing individuals
can all use their personalities as an strength in  a particular work position.  Moreover, many people have fetishes or engage
in what the society may consider amoral, unacceptable or dangerous.  However, these people are still able to function in
the society as productive citizens as long as they engage in these activities in a consensual and/or private manner.  
Some disabled individuals like many in the society have certain passions that maybe unacceptable to us.  If we encounter
individuals with disabilities with similar problems, be it behavioral or otherwise, our first attempt is to eliminate the
behavior through training, education, behavior modification, medication and other methods.  However, if all fails, learning
the skills to cope with these desires and soliciting them only to another consenting adult may be a solution.
In the assessment page you will find fifteen skills categories with which one can conduct a comprehensive evaluation of an
individual's skills.  Once the full  assessment is conducted, the deficit section of the assessment becomes the focus of the
program writer.  It is important to prioritize these weaknesses since there may be many of them.  The program writer then
determines which of the categories should be the primary focus and which secondary.  For example, the program writer
evaluates that health and hygiene and personal and social skills take precedent over leisure, time management and reading
and writing because the individual attends a day program and has hygiene and behavioral issues that might jeopardize the
person's ability to maintain enrollment in that program.  Similarly, in this case, both behavioral and hygiene issues each
must be sub-categorized based on importance into primary and secondary objectives.  For example, physical aggression
may take precedent over verbal aggression and bathing over fingernail trimming.   
Once the assessment process is complete and primary categories (goals) are selected and primary objectives are chosen,
the program writer utilizes a method with which to collect data for each objective to determine its effectiveness over time.  
The method requires two principals in order to be useful in functional analysis.  First the objectives need to be written in a
form of a behavior.  For example, "Using a timer, I will follow the day program rules and remain in my assigned area."  
The behavior is to remain in assigned area and the tool utilized is the timer.  
Second, the objective needs to be measurable.  This requires the program writer to determine a baseline as to at what level
is this individual capable of remaining in his assigned area.  To achieve this, the program writer may observe the person,
collect a few months of data taken by staff at the site, or look up past performances.  For example, based on past
performances, the individual is currently 30% (baseline) independent in remaining in his assigned area. The program writer
then needs to determine whether the tools being used are the most affective or do they need to be modified in order to
increase the person's chance of success.  Another determination is the ratio of success for the expected duration and the
numbers of repetitive training and testing.  In this example, the program writer may determine based on past performance
the individual may succeed at becoming 42% independent within a year time when training is provided 12 times a month.  I
have provided a sample of a basic
blank data sheet sample that can be used in a workshop setting as well as one that can
be use in a
residential setting.   
I can not emphasize enough the importance of breaking down every skill into steps and keeping things as simple as
possible.   For example, an objective "I will brush my teeth daily"  is not an acceptable objective if the person is not
capable of gathering his toothbrush and toothpaste, place the correct amount of toothpaste on her toothbrush, brush her
front upper and lower teeth, brush her inside lower teeth and etc..  A program writer may review the most recent dental
evaluation or consult with the dentist to determine exactly what area of oral hygiene requires special attention.  An
appropriate objective for a person may look like this:
"I will improve my oral hygiene by paying special attention to the inside of my upper left teeth".
Lastly, the program writer needs to provide some instructions and methods for the implementers as to how these objectives
are to be achieved.  Some methods may require the implementer's assistance in helping the individual meet the criterion on
her data, other methods may be verbal prompts and encouragements or just stating to the individual what are the
consequences of each choice they make.
Some intervention skills
when working with
challenging persons.
                                            Objective setting guidelines                                                                                
1-  Determine Annual Goal(s) by prioritizing individual weaknesses based on importance.                                    
2-  Set an annual goal in the form of a behavior.                                                                                                  
A.  Identify variables (objectives) that hinder the individual's ability to reach the goal                                       
B.  Prioritize and list objectives from most important to least important                                                              
C.  Determine a process to make weaknesses into strengths                                                                               
D.  Prioritize objectives based on most achievable to least achievable before setting criteria  
E.  Determine the baseline at which the individual is currently functioning, i.e., 20% independent                      
F.  Divide objectives into primary and secondary  
*  When individual meets primary objectives, secondary objectives will be initiated as
**  When writing staff methods, staff always aids in the progression of the objectives with least amount of
assistance (unless specified)   
Example Goal setting
  Increase Production
      Objective: 1A
          Easily distracted by other's activities
I will limit my visual stimuli by concentrating on my task
        D. Primary
          Objective: 1B
          Wants to know where G/F is at all time
I will follow work rules and limit my contact with my girlfriend to lunch and break time only.
          Worries about snack time
        D. Secondary
          Worries about missing the bus
            Objective: 2A
          Poor hand/eye coordination
I will follow occupational therapist recommendations/instructions while performing my tasks
        D. Primary
          Objective: 2B
          Wants others to do his tasks for him
I will refrain from asking others for non-emergency assistance while performing my task
          Will not use walker consistently
        D. Secondary
          Excessive bathroom use
Assessment page
Ask Dr. De Roeck
Dr. De Roeck has been a monthly contributor to
this site since 9/2011. He will randomly select and
respond to one psychiatric related question
submitted by the members and readers each month.  
The answers will be archived for reference.   

Dr. George De Roeck is a Counselling Psychologist
with over 30 years experience.  He is licensed in
Arkansas and Missouri, and is certified as a National
Health Service Provider in Psychology.  
For additional information contact:
Psychological Care Center
Go to Ask Dr. De Roeck archive page
Behavior Incident Report