Active Treatment

A large portion of being a Qualified Intellectually Disabilities Professional (QIDP) is to ensure that each resident is provided with consistent, quality, active treatment on a daily basis. Active treatment, also referred to as developmental programming is both a concept and a formal procedure with specific parameters and guidelines as specified in the regulations. Human beings tend to grow and progress in a sequential, orderly, and predictable manner and the rate and direction of development can be influenced by systematic opportunities for learning.

ACTIVE TREATMENT IN ICF-DD SETTINGS

Active treatment, as a concept is the skill-training residents receive to help them function as independently as possible. Active treatment per regulations is the aggressive and organized attempt to reach each resident's fullest functional capacity. Each person has their own rate of development, so the goals which should be set for them depend largely upon the particular developmental skills they already possess and their specific developmental needs. Each resident will receive an individually tailored program specifically aimed at achieving their own developmental objectives. This program is referred to as an Individual Service Plan (ISP).

INTERDISCIPLINARY TEAM

An Interdisciplinary Team (ID) consists of various professional consultants ranging in area of expertise, and may include an occupational therapist, physical therapist, recreational therapist, speech therapist, psychologist, dietitian, and a registered nurse. Each consultant is responsible for developing an updated formal written assessment of the resident, which is presented to the team on a bi-annual basis. Any member of the team may call together a meeting at any time through out the year.

INDIVIDUAL SERVICE PLAN MEETING

The purpose of an Individual Service Plan (ISP) meeting is to gather the ID team with the resident, family members or conservators, a day program representative and a Regional Center caseworker together with the QIDP for a formal meeting twice annually to discuss progress with the current plans. The QIDP may also have assessments depending on the structure of the meetings. Additionally, the team discusses how the resident is doing, whether the objectives are being met, and the next steps involved. The QIDP coordinates all services and follow-up plans and writes the ISP--a more general plan. The QIDP also coordinates formal training goals and objectives and writes the Individual Program Plan--[CE3]--a more specific to training program. The QIDP directs the in-service care staff on how to implement the written and informal plans agreed upon by the team, helps prioritize and writes monthly and quarterly reports demonstrating progress made with these objectives. ID teams are not technically limited to a bi-annual meeting (one during the resident's birthday month and a follow-up meeting six months later). As a resident's needs change perhaps due to illness, a significant change in medications, behavior changes or maturity, so does the need to adjust their treatment plan. This may include a new or temporary nursing care plan, changes in skill training programs, coordination with doctors, treatment centers, and day programs. It may also require coordinating an interim staffing change with the ID team. There are specific rules involved in writing assessments, plans, objectives, ISP's and Individual Program plans , reports, reviews and data sheets that we will not go into here.

MEASURABLE GOALS AND OBJECTIVES

Effective training requires the development of specific goals and objectives for each resident. Goals can include such activities as 'improving self-feeding skills, or improving personal dressing skills, or improving behavioral skills. Objectives are more specific and detailed. They must be expressed in simple observable and measurable terms so that competent observers can understand what the objectives are and can agree on whether or not they have been met. Observation in this context may be construed to refer to any apparent activity displayed by a resident. If the activity is not apparent, observers will likely be unable to agree on it. For example, suggesting that Jane will develop good eating skills is too general and is not an objective expressed in measurable terms. Observers may have different opinions on just what good eating skills are, and how one knows when such good eating skills have been achieved. Objectives which contain words like "to know," "to understand," "to enjoy," accordingly are also unacceptable because such words are subject to a wide range of interpretation. New and revised goals and objectives often emerge from previous ones, so that overall, an active treatment plan is actually a long series of short-term, goals, which converge on long-term goals. The observer should be able to follow a developmental sequence. Now, it is possible to measure specific objectives in the eating process that are specific, measurable, prioritized and sequential steps in ability the individual can achieve.

EXAMPLE:

GOAL: To improve self-feeding skills.
OBJECTIVE 1: Jane will set her glass on the table after drinking without spilling in three out of five trials with verbal prompts to achieve 30% success for four consecutive months.
OBJECTIVE 2: John will take his plate to the sink when finished eating 20 out of 30 times with continual guidance for two consecutive months.
Objectives need to be included in the resident's individual daily schedule to help achieve consistency. Specifics regarding writing good measurable objectives will not be covered here).

METHODOLOGY AND TRAINING PLANS

In addition to including a statement of specific, precise, and measurable objectives, each training program for a resident must incorporate a clear plan describing the systematic techniques or methods to be used in order to achieve those objectives. Such a plan is necessary to ensure that all staff can implement the training program the same way each time. Each plan must have a form of data collection that clearly reflects the resident's level of achievement or progress toward meeting the objective. The plans need to be written in simple straight-forward language that the direct care staff can follow on a daily basis. It is the QIDP's responsibility to ensure that the staff carries out the plans correctly and revises the plan as needed.

MONTHLY AND QUARTERLY ISP REVIEWS

The QIDP is responsible for taking the data collected by staff and incorporating it into a monthly review. (There are specific guidelines for data collection and reviews which will not be covered here). Each resident will have their progress or lack of progress noted and compared to the previous month. Additionally, quarterly reviews are compiled which comprise the prior three consecutive months and the results compared to the prior quarterly progress.. As a result of the monthly and quarterly reviews, it may be necessary for the QIDP to discuss the results with the in-service staff regarding the data collection, and/or implementation of a plan, revise a plan or go back to the ID team and re-evaluate an objective. The reviews address more than just the specific objectives progress. They also address health concerns, day program contact, use of trust account money, family and social involvement, rights, and community integration. The information collected and processed will then be presented to the ID team at the next review meeting, and the process begins again.