Bamburg, PhD, Shannon H. The process of providing continuous active treatment in a functional, meaningful format continues to evolve in the field of intellectual and developmental disabilities. The growing need for treatment and training in real-life, real-time settings, in conjunction with the advocacy, normalization, and community movements, dictates that providers of service think "out of the box" to develop a wider array of life and learning opportunities.
The present work describes a system for accomplishing continuous active treatment in structured settings, the residential milieu, and the larger community. Focus of the work includes systems change that is both efficacious and effective, the Positive Behavior Supports PBS framework, and outcomes based in improved quality of life QOL.
Data are provided to support the critical elements of the program, including learning opportunities, meaningful engagement, types of environmental interaction, reinforcer delivery, choice, indices of happiness, behavioral excesses and deficits, and community integration opportunities. These data, along with implications and future directions of the program, are considered and discussed. It takes a lot of courage to release the familiar and seemingly secure, to embrace the new. But there is no security in what is no longer meaningful.
There is more security in the adventurous and exciting, for in movement there is life, and in change there is power A. Cohen, personal interview, Gone are the days of the stand-alone medical model, a focus on singularly eliminating problematic behaviors, and teaching only those skills required for assimilation into congregate living settings. Today, the focus has become quality of life QOL ; that is, the supports, learning opportunities, and real-life activities required to enable people to experience happiness and inclusion, and to become meaningful contributors to the larger society Carr, The cultural and systems changes that must occur in order to support a QOL- based model of assessment and treatment are often difficult to achieve.
In order to achieve a change of this magnitude, a number of processes and tenets must first be established and implemented. First, administrative direction must be centered and focused on moving people with intellectual disabilities, their staff, and the larger agency towards the achievement of meaningful outcomes and improved quality of life. Agencies must be structured to achieve these goals from organizational, budgetary, and programmatic standpoints, and this philosophy must become the vision of the agency and the known mode of operation.
In addition to an administratively driven vision, providers of service must also choose a philosophy of care that personifies the visions of people with intellectual disabilities as well as the larger agency. The core elements of PBS include broad based assessments and supports, teachable moments in both classroom and real-life settings focusing on both efficacy and effectiveness , an emphasis on the elimination of problematic or challenging behaviors through the acquisition of appropriate pro-social skills, meaningful engagement with staff, peers, and environments, access to preferred activities and reinforcers, and maintenance of this philosophy across times and settings.
The PBS model is strength-based and emphasizes skills that enable each individual to work increasingly towards an improved quality of life. The focus is not on achieving a "cure," but on enabling the individual to use personal strategies and benefit from engaged, enriched environments that support functional, meaningful outcomes Singh, Total population of PDC is approximately people. Residents of PDC are mostly white, ambulatory, and function in the severe to profound range of intellectual disability.
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PDC systems are reviewed with a focus on treatment planning, habilitation malls, the therapeutic milieu, and community based learning opportunities. The core features of the program involve the participation of each individual and his or her integrated treatment team into an Individual Support Plan ISP. The ISP is an individualized summary of supports and services. The interventions outlined in this document are building blocks designed to enhance autonomy, independence and improve overall quality of life. The document is also amendable based on ever-changing consumer needs.
This treatment planning document contains all treatment mall classes, therapies, and supports that an individual is engaging in in order to promote habilitation and wellness. The integrated treatment team, with each individual, is responsible for the design, implementation, monitoring, and modification of each treatment plan. This process serves as the catalyst in the treatment model to overcome barriers and transition to the next level of care.
The interdisciplinary treatment team is continually involved in the planning, implementation and review of individual and treatment mall activities. An appropriately structured psychosocial treatment mall addresses the functionality of learning activities and the context in which the skill is trained. The goal is to promote and develop engaging environments that support functional meaningful outcomes. Readers can find a more thorough review of this base process for active treatment in Thorn, Bamburg, and Pittman, Habilitation treatment malls constitute a focused approach of service delivery that allows an agency to maximize time in treatment and resources by providing a large array of services.
Treatment in the mall setting is provided, as much as possible, in the context of real-life functioning and in the rhythm of life of individuals. Therefore, a fully-functioning mall extends beyond the context of a building or place to provide treatment, habilitation, and enrichment across times and settings.
The milieu is developed utilizing components of PBS such as teachable moments, meaningful engagement, access to preferred activities, and acquisition of appropriate skills in the "rhythm of life" context.
This menu of skills becomes the focal point of teaching, reinforcement, and generalization in the residential milieu and is utilized across times of day. This process of teaching, engagement, and reinforcement breaks the mold of traditional residential groupings for meals, activities, and completion of ADLs and allows individuals to share activities and experiences based on personal preferences and individual needs.
The process further builds momentum as experiences and preferences are shared and create a cycle of discovery for each individual and their staff. This expansion can include other learning-based supports and therapies, service-based supports, personal goals, interests, and preferences. Additionally, the training and reinforcement of these skills can be adapted to additional settings. Once the link between the therapeutic milieu and ISP becomes part of the staff mindset the environment becomes the source of an ever-changing learning opportunity with the potential for a limitless supply of information and reinforcing contingencies.
The development and implementation of the agency-based milieu has broader implications than care for the individual. Teaching and treatment implementation strategies begin to make sense and staff's role in the treatment team model is validated and essential. The data elements considered in analysis of the milieu include teaching opportunities available and implemented, reinforcers available and delivered, presence and management of challenging behavior, the nature and quality of environmental interactions, indices of happiness, and choices available and taken.
Data for elements was collected on the individual program observation form and are presented for the calendar year This group observations data are reported in terms of group engagement percentages e. These data are collected on a daily basis by clinicians and residential administrators. These results are usually based on a individual to staff ratio for ambulatory individuals Reid et al, A functioning therapeutic milieu can greatly effect engagement based on both the flexibility and consistency of the available activities.
Instead of matching activities to groups, there is a match of people to preferred activities, which can promote secondary group formation. Data presented below represent facility engagement percentages for groups of individuals who are ambulatory, non-ambulatory, and function across the full spectrum of intellectual disabilities. Data collection covers a twelve month period, calendar year In bringing up drones, I am not trying to make a political statement, but rather point out that much of the discomfort people feel toward this technology and software, exists in the functions of things we use every day on a personal level.
As mentioned by Manovich, various types of interface components have been embedded into our culture and we expect technology to be able to produce the outputs we desire. Is it solely political? Does it make us super aware of the actor network theory in action? Or is it something else embedded into the human side of the interfacing? It seems as though much of the debate about drones is rooted in our difficulty of pinpointing the answer to this question, which truly demonstrates how software is permeating all levels of our culture.
The world of the internet, social media, mobile applications, and instant sharing of information has become the main influence in shaping culture, ideologies, and trends. What is special about the internet, however, is that it participatory, where users are not only receivers of information, but are the creators of it. The following video went viral a couple of months ago. However, programming is not the only skill that can effective in shaping the digital world.
They are givers rather than takers, producers rather than consumers. People who are skilled in any of those pursuits, and who successfully share their content on the web tend to gain near-celebrity status at many times. Examples are numerous, and can be found all over user-generated content websites such as YouTube, Tumblr, Deviantart, and more.
It is also interesting to observe the spread and sharing of such skills through numerous tutorial websites, videos, and other forms. Anyone interested in learning a skill, whether it is programming, videography, or digital sound production, can find unlimited resources from other people who are experts at them.
- Crazy For You.
- Noise Reduction in Speech Applications (Electrical Engineering & Applied Signal Processing Series).
- Week Digital Milieu / Digital Culture | CCTP Media Theory and Digital Culture.
- Writer's Digest Magazine.
- Little Wolf’s Book of Badness;
- NADD Bulletin Volume XIII Number 1 Article 1.
A lot of successful content creators today are self-taught. It is hard to find an internet user today that has not contributed at least a little to the cultural content of the web.
What is for sure, however, is that the more knowledgable and skilled a person is, the more influential they are expected to be. Certain theories resonate more strongly with some analysts and not with others. Consequently, the tool kit that I have begun to outline here may be particular to my interests and is not intended to be used as a general reference.
Most media artefacts were not created in a vacuum, and their histories may reveal a new issue or perspective. For example, I can use a computer but I may not understand the technical details involved in saving my documents or sending an email. Consequently, it is important to ask: What does the user see and interact with?
What is invisible to the user? Semiotics There are a large variety of semiotic concepts to choose from when analyzing media. For example, if I were analyzing a web comic I would draw from Chandler when studying specific panel construction. Cognitive Processes and Interface It seems more effective to group cognitive science and interface together because interactivity between a media interface and users usually demands some form of cognitive work on the part of the user.
If we return to the web comic example, the semiotic analysis may reveal certain meaning-making processes involved in reading the comic. The cognitive and interface analysis might uncover certain aspects that are not covered by semiotics. This includes how a user interacts with the software that displays the web comic. Powerful Combinations Intertextuality and intermediality could be explored as the final component of the toolkit. Manovich, Bolton, Grusin, and Clark discussed the ways in which media forms encapsulate each other in the same way that a Russian nesting doll is constructed.
An iPhone, for example, is composed of many different media forms that came before it including the photographic camera, video camera, telephone, etc. Intertextuality can be analyzed under this topic as well, but may be more applicable to a text within the media artefact.
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The iPhone provides users with a personal assistant named Siri. If the user asks certain questions, Siri will answer with jokes and ironic statements that a user may only be able to appreciate if she or he is familiar with another text such as the Star Trek series. I look forward to refining this tool kit and perhaps applying it to a case study as the semester comes to a close.
Additionally, I would like to point out two concepts that stood out to me in regards to interface. Consequently, this interface for tagging leads many users to refer to tags as places rather than labels. This implies that there are physical boundaries in place around each tag. These boundaries may be breached when a user adds a label to a blog post, but the language surrounding this action implies that the offending user has walked into a room as an unwelcome guest. Hypomnesis Another concept discussed in terms of interface is hypomnesis.