Speeding Up Day Habilitation Service Delivery!

6/12/2015
 

Guest Bloggers: Stuart Law, B.A., Tara Grant, M.S., Ryan O’Donnell, M.S., BCBA

At the “iChoose” department of High Sierra Industries, Inc. (HSI) in Reno, NV, we operate a fairly large service; helping over a 100 individuals with various disabilities and challenges from the hours of 8:30 am to 2:30 pm. We support people in an activity-based day habilitation service from 1:1 to 8:1 ratios.

As you might imagine, people who receive 8:1 staffing services don’t leave a ton of time for implementation of intensive habilitation goals. Historically, the habilitation goals written by care and service providers for 8:1 contracts have yielded little in the way of significant life changes. Frankly, our service was failing in delivering learning outcomes to individuals with high staffing ratios. Our failure to measure accurately, often, and in actionable ways, was a large part of the problem. One person who attends our program at 8:1, Nick, had a fairly straightforward plan.

Nick’s plan had been to write his name. Handwriting skills are important for signing documents (i.e., self-advocacy), paychecks, and even for participating in social interactions (signing a birthday card). And it struck all of us that Nick deserved the skill of writing his name. Handwriting was something that HSI had worked on for approximately 3 years. Nick was in his thirties and still could not write his name reliably or legibly. His ‘N’s often came out backwards, the letters would be written all over the page, and would often be out of order. Our staff were defeated and were skeptical that Nick would ever write his name fluently.  

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Nick’s “name writing” program was one of the first to move to data collection and analysis through Chartlytics. We started with the component skill of writing the single letter  ‘N’—then ‘I’. But before we could even get to ‘C’ and ‘K’, Nick was already writing the whole thing at an increasing rate, and with increased accuracy. We knew to skip ahead. Through frequency (data) monitoring on the Standard Celeration Chart, we quickly identified effective and ineffective elements of the teaching program, and implemented changes specific to Nick’s needs. Better still, Nick had historically avoided this program, but with staff sharing their excitement Nick loved his program (he earned money that was exchangeable in the “Chart Mart” – our internal economy devoted to promoting learning through tangible rewards typically inaccessible to people in this service model). Nick would frequently remind his staff that he needed to work on his handwriting and even wait outside the room where the program was to be run. 

In short, by using the Standard Celeration Chart through Chartlytics, we had excited staff that were sensitive to subtle changes in performance. They cheered Nick’s personal bests and ‘tried again’ when timings visually showed the lack of progress. Staff also took accountability for failures and took strides to constantly improve their approach. Nick quickly demonstrated the ability to fluently write his whole first name. By the time his next meeting rolled around, he wrote it clear as day on the appropriate line of his paperwork. 

Nick's "hear-writes name" Chart from Chartlytics

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Nick’s hear-writes name data set chart. First we focused on single letters “N” and “I”. Nick quickly made progress and we jumped ahead (skipped “C” and “K” in isolation) to his full name. After about 8 weeks of growth we signaled when Nick should move to the next letter as a way to speed up his transitions from letter to letter. Lastly, we moved to other methods (white board, pen and paper, etc.) to ensure fluency!

Takeaways

  1. Start collecting daily data and chart it on a standard chart – it will allow you to identify and reward positive growth
  2. Break up the complex skill into component skills, in this case we focused writing "N" and then "i" 
  3. Identify effective and ineffective interventions – prior to this chart Nick had been working for approximately 3 years through a variety of “prescribed” interventions that didn’t include daily data analysis

Chartlytics, and Nick, have taught our staff that being a good teacher isn’t about style, it’s about following data and adapting to your learners. It’s about caring enough to Chart!

Stuart, Tara, and Ryan

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