Education and Training in Autism and Developmental Disabilities

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nosed with intellectual disabilities. The deinstitutionalisation plan recommended the exit of all the residents (N 487) in four successive cohorts spread out over a period of four years between 1999 and 2002. It was planned that the residents would be integrated in the community and benefit from various services developed by two rehabilitation centers, specialized in intellectual disabilities, in surrounding areas. The province of Quebec contains 23 of these public rehabilitation centers. These centers offer adaptation, rehabilitation and social integration services to people with intellectual disabilities or with Pervasive Developmental Disorders (PDD), as well as support services to their families. Three distinct types of residential services are available: resources of family type (RFT), intermediate resources (IR) and continuous assistance residences (CAR). The RFT is a foster family that accommodates people in their home. The CAR is a residence in which a high level of support (24 hours/7 days a week) is provided by employees of the establishment. The IR is a mixed model. It is distinguished from the RFT by the expertise and the extent of services required by the person, which are beyond that offered in the RFT yet below that found in the CAR. In both the IR and RFT, one person is in charge. Staffs are also present in the IR but do not intervene on a 24 hours/7 days basis. In the transformation plan, the development of an evaluation and monitoring model was conceived to ensure follow-up of the residents’ progress. Consistent with this aim, the focus of the present study was to understand the evolution of the residents who had been reoriented in community-based resources following a long stay in an institution. Variables studied were relocation, adaptative and maladaptative behaviors, mental health problems and medication. This study was based on the approach in which data is provided from questionnaires, completed by advisors others, systematically collected and linked to medication and relocation. Method Participants The sample was composed of 78% (n 136) of the residents that left the institution to be directed towards a service center of the surrounding area. Of this group, 83% were women (n 113) and 17% men (n 23). The mean age at time of discharge from the institution was 52 years old (SD 9.05). The severity of the deficit related to the adaptive behavior was measured with the Échelle Québécoise des comportements adaptatifs (ÉQCA) (Atelier québécois des professionnels sur le retard mental, 1993). Based upon this measure, 76.5% of people presented a profound deficit (n 104), 14.7% a severe deficit (n 20), 5.9% a moderate deficit (n 8) and 1.4%, a mild deficit (n 2). Measures Relocation. All changes of residence that took place following exit from the institution were recorded. Each one was characterized according to the difference in the degree of support offered by the two residential resources involved. The person could be either directed towards a model offering less support (CAR towards IR, CAR towards RFT, IR towards RFT), same degree of support (CAR towards CAR, RFT towards RFT, IR towards IR) or more support (IR towards CAR, RFT towards IR, RFT towards CAR). The reasons given for relocation were regrouped in categories and then consigned according to whether they were related to the person (health, behavior, autonomy, getting closer to the family) or independent of the person involved (reason related to the RFT or to a reorganization of the residential service). Adaptive behavior. Adaptive behaviors were measured with the Échelle Québécoise des comportements adaptatifs: ÉQCA (AQPRM, 1993) questionnaire with the aim of obtaining an accurate sense of the persons’ adaptive skills. This questionnaire contains 324 items, separated into two distinct sections. The first section, which contains 225 items divided into seven spheres, measures various aspects of adaptive behaviors (autonomy, domestic skills, health and sensorimotor skills, communication, preschool and school skills, socialization, work skills). Each item is assigned a score from 0 to 2(0 does not do it; 1 doit...butonly when told to do so, sometimes, not completely ...;2 do it). The ÉQCA has good test-retest Deinstitutionalisation and Adaptation / 367
eliability (r .92) and good inter-rater reliability (r .83) (Tassé & Maurice, 1993). Maladaptive behavior. The second section of the ÉQCA measures maladaptive behavior. This section contains 99 items divided into seven dimensions. These dimensions are related to stereotyped behaviors and odd postures, withdrawal and carelessness behaviors, unacceptable practices and habits, antisocial or inappropriate interpersonal manners, inadequate or divergent sexual behaviors, violence or aggression behaviors, and self-mutilation behaviors. Each item is assigned a score from 0 to 3 according to the severity of the inadequate behavior (0 does not exhibit the behavior; 1 mild; 2 moderate; 3 severe). A mild inadequate behavior refers to an occasional or benign behavior that may require an isolated intervention from caregivers. The moderate type behavior is the one that requires a generalized or concerted action leading to the application of a treatment strategy to modify the presented behavior. Finally, a severe behavior is considered to be so when it may constitute a danger to the person or other people, or lead to the rejection of the individual. Mental health problems. The translation and transcultural adaptation section (Lecavalier & Tassé, 2001) of the questionnaire Reiss Screen for Maladaptive Behavior (Reiss, 1988) was used with the intention of creating a portrait of the mental health condition of the participants. The instrument was originally developed to detect the presence of mental health problems of teenagers and adults presenting intellectual disabilities. The instrument is composed of 36 items describing the symptoms of one or more mental health issues, as described in the DSM-III. For each item, the respondent must indicate if the behavior does not represent a problem (0); a problem (1); a major problem (2); a problem that can be identified by one of the multiple criteria defining psychopathology: the frequency, the intensity, the circumstances of appearance and the impact for the evaluated person or for his environment. It is composed of eight subscales: aggressiveness, autism, psychosis, paranoia, depression (behavioral signs), depression (physical signs), dependent personality and avoidance disorder. In addition to these eight sub-scales, six items describe problem- atic behaviors: drug abuse, self-mutilation, suicidal tendencies, robbery, inappropriate sexual behaviors and hyperactivity. A positive score is obtained with this evaluation if the total score measured by the eight subscales exceeds a cutoff or when a major problem is detected on one of the six items. The translation and French adaptation of this instrument was made up by two committees composed of bilingual professionals with expertise in the field of mental retardation. The internal coherence indices for the eight sub-scales of the original version of the instrument vary between .57 and .84 and that associated with the total score is .84 (Reiss). As is mentioned by Lecavalier and Tassé (2001), the translated French version of the instrument adapted to the Quebec reality obtains similar internal coherence indices, that is, between .53 and .83 for the eight subscales and .80 for the total score. Medication. The data related to psychoactive drug medication were collected and recorded on cards designed for this purpose. The drug’s name and its posology, as well as the dates related to some modifications in the regulation of medication, were recorded. This type of drug could either be in the nerve sedative (antipsychotic) or anxiolytic (benzodiazepines) families. With the intention of obtaining a measurement common to the various prescribed drugs, equivalences were calculated: the amounts of drug prescribed in the nerve sedative family were converted in CPZ (chlorpromazine) and the amounts for those in the anxiolytic family, in Diazépam (or Valium). Procedure. The questionnaires used to measure the adaptive and maladaptive behaviors and mental health problems were completed by caregivers who knew the person, in collaboration with a member of the staff in charge of the residence where each resident lived. Each person was evaluated at two time points: at the third month (Time 1) at the 27th month (Time 2) following discharge from the Hôpital Saint-Julien. For each person, a specific personal observation file entitled Individual observation file (IOF) was created. This IOF included the instruments, the grids of notation and the instructions to be followed with every person evaluated. The original data were recorded in this file and, in some cases, 368 / Education and Training in Autism and Developmental Disabilities-September 2010
Page 1 and 2: Education and Training in Autism an
Page 5 and 6: Manuscripts Accepted for Future Pub
Page 7 and 8: dents in classes that included stud
Page 9 and 10: TABLE 1 Summary Descriptors of Meli
Page 11 and 12: tions were conducted at their work
Page 13 and 14: her function more independently wit
Page 15 and 16: eluctant to engage in interactions.
Page 17 and 18: ehaviors were consistent with Phill
Page 19 and 20: disabilities. Second, it has promot
Page 21 and 22: youth with severe disabilities. Min
Page 23 and 24: parents of students with intellectu
Page 25 and 26: tributed to such PSE program compon
Page 27 and 28: TABLE 2 Mean Scores of the 7 PSE Pr
Page 29 and 30: that educators’ and parents’ po
Page 31 and 32: gan, 1997). Despite the challenges
Page 33 and 34: ing the total score of the Family A
Page 35 and 36: with the identified factors being r
Page 37 and 38: of a positive outlook has been docu
Page 41 and 42: TABLE 1 Demographic Characteristics
Page 43 and 44: ways in the same interviews where s
Page 45 and 46: In a number of comments, respondent
Page 47 and 48: practitioners assigned both issues
Page 49: Education and Training in Autism an
Page 53 and 54: TABLE 2 EQCA Adaptive Behaviors: Me
Page 55 and 56: TABLE 5 ERDCP: Means, SDs, and t Te
Page 57 and 58: teen of these studies (90%) reveale
Page 59 and 60: practice may have had an influence
Page 63 and 64: ing to questions, (c) the learner f
Page 65 and 66: around a small instructional table
Page 67 and 68: TABLE 2 (Continued) 9. Guide studen
Page 69 and 70: TABLE 3 (Continued) Student Steps B
Page 71 and 72: TABLE 3 (Continued) Student Steps D
Page 73 and 74: esponding to errors by interrupting
Page 75 and 76: Figure 1. Teacher’s number of ste
Page 77 and 78: Figure 2. Number of inquiry skills
Page 79 and 80: TABLE 4 Results of Parent Survey It
Page 81 and 82: data was not simply an artifact of
Page 85 and 86: TABLE 1 Students’ Description Sub
Page 87 and 88: served a communicative function. In
Page 89 and 90: Descriptive Analysis The first rese
Page 91 and 92: eakdown whenever it is the case. He
Page 95 and 96: stood attribution when two consecut
Page 97 and 98: within easy reach. The instructiona
Page 99 and 100: and provided Takao a pen with thin
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Figure 3. Percentages of correct re
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teacher whether we should fully hon
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Education and Training in Autism an
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components to be effective promptin
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ability (IQ 44, Stanford-Binet Inte
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TABLE 1 Task Analysis for Cooking R
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pographic); and (c) no response, ch
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Figure 2. Percentage of steps perfo
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Figure 4. Percentage of steps perfo
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ture audio feature of the PDA, but
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M. (1992). The effects of self oper
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Education and Training in Autism an
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TABLE 1 Stages of The Halliwick’s
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plete other steps (Tekin & Kɹrcaal
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Figure 1. Percentage of correct res
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Martin, J. (1981). The Halliwick Me
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systematic instruction to teach fou
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also extremely low with a standard
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Procedural reliability probes measu
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Discussion The purpose of this stud
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(1986). Stanford-Binet Intelligence
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focus on the important adults in th
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cording to the current environment
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that “she felt very inadequate in
Page 149:
tive research. (2 nd Ed.). New Jers
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