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Originally Processed With FOIA(s): FOIA Number: S S FOIA MARKER This is not a textual record. This is used as an administrative marker by the George Bush Presidential Library Staff. Record Group/Collection: Donated Historical Materials Collection/Office of Origin: Frieden, Lex, Collection Series: Disability Rights Organizations Subseries: OA/ID Number: 52064 Folder ID Number: 52064-009 Folder Title: [TIRR] New Options Proposal and Correspondence [1974-1977] [2] Stack: Row: Section: Shelf: Position: TIRR TRANSITIONAL PROJECT The TIRR transitional project will provide training in social adaptive skills for persons with severe physical disabilities. The live-in program is designed to last approximately nine weeks for each participant. Some persons may need less training and leave the program after a shorter period of residence. Others may profit from additional special services such as drivers' training, a formal vocational evaluation, or time in a practice living situation which may require more time. During an individual's first week in the project, he or she will be introduced to the various program activities and to the project techniques of self-assess- ment and goal-setting. The participant will develop an individualized program plan with project staff members which will be formulated in a contract specify- ing what is expected of each party. Each participant will be assigned a buddy at the beginning of his or her stay. The buddy relationship will serve as a focus for work on social interaction and interpersonal relations throughout a person's stay in the project. The program will be organized so that all subject areas are covered in an eight- week period. Some on-going activities will be scheduled on a weekly basis. Other program areas will be developed as short-term training modules which are sche- duled in an eight-week sequence. The various program elements are described below. social skills group 3 hours per week Two sessions of 1 1/2 hours each will be conducted per week by a social worker, to deal with social relationships inside and outside the project, family relationships, feelings about self and the future, and other areas as appropriate. weekly seminar on educational and vocational opportunities 4 hours per week Seminar will be conducted by a vocational counselor to include group dis- cussions and numerous field trips to colleges, vocational training programs, and employment locations; active handicapped persons in the community will be involved as resource persons. weekly seminar on living arrangements 4 hours per week Seminar will be conducted by core project staff to include group discussions and numerous field trips to nursing homes, residential projects, a college dormitory, and individual living arrangements; active handicapped persons in the community will be involved as resource persons. 2 weekly buddy counseling 1 hour per week Individual and joint-counseling by project social worker will focus on buddy relationship as a means of developing an understanding of other persons and skill in interpersonal interaction. weekly consultations with RN, PT, OT 1 1/2 hours per week These professional staff members will be available one morning a week to serve as consultants to project participants in assessing their needs and devising programs to meet these needs; to include long-term planning as well as dealing with immediate problems. weekly mobility assessment group 1 1/2 hours per week A weekly meeting will be conducted by core staff members to examine mobility problems encountered by participants on various field trips and to consider ways of dealing with these problems. weekly sex and coffee group 1 1/2 hours per week A weekly group will be conducted by the project social worker to examine attitudes and feelings about sexuality, role expectations, and dating. weekly evaluation and assessment session 3 hours per week One morning per week, participants will take part in an evaluation session- to be supervised by core project staff. These sessions will fill two pur- poses. One is to measure the individual's status in various program areas as an aid to self-assessment. This information will be used by the partici- pant in formulating plans for the coming week. The second purpose is to provide information to the staff about the effectiveness of various program elements. weekly group on problem-solving 1 hours per week This group will meet :in the afternoon following a morning assessment session to assist persons in considering needs, specifying goals, and formulating plans formulating plans for the coming week. Long-range planning will also be emphasized. weekly group for significant others 1 1/2 hours per week A group will be" conducted one evening per week as needed for family members, spouses, close friends, or counselors of project participants. The group will consider the transitional experience of the project participant, examine the SO's feelings about these changes, and help the SO in being a supportive influence after the participant has left the transitional project. 3 field trips Field trips into the community will be included in many program activities (visits to vocational training sites and residential projects, for example). In addition, other trips to shopping areas, recreational activities, etc. will be regularly scheduled with participants to be involved in trip plan- ning. After each trip, participants will complete a form concerning their social interaction on the trip and a form on mobility problems they en- countered. These experiences will later be discussed in group sessions. short-term training modules, cycle I 41/2 hours per week Short-term training programs in self-care and medical needs (two weeks), functional skills (three weeks), and homemaking skills (three weeks) will be conducted by an RN, PT, and OT respectively. These modules will meet three mornings a week (1 12 hours per session) for the designated number of weeks. They will be scheduled one at a time in an eight-week. cycle. short-term training modules, cycle II 41/2 hours per week Short-term training modules will be conducted by core project staff with substantial involvement of active handicapped persons in the community. Subject areas will include attendant management (two weeks), financial management (two weeks), mobility and transportation (two weeks), consumer affairs (one week), and leisure activities (one week). Groups will meet three afternoons a week (1 hours per session) for designated number of weeks. Modules will be scheduled one at a time in an eight-week cycle. These activities will be combined in a weekly schedule as indicated below. The scheduling will be varied às the project progresses to test the effectiveness of alternative arrangements. TENTATIVE WEEKLY SCHEDULE / TIRR TRANSITIONAL PROJECT MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY WEEKENDS module I buddy coun- module I module I evaluation field trips seling & self- MORNING consultations social skills field trips staff meeting assess- ment group buddy coun- consultations seling buddy coun- seminar on mobility seminar on problem- field trips seling vocational- assess- living solving AFTERNOON sex and coffee educational ment arrangements group group opportuni- social skills module II module II ties group module II SO group field trips field trips EVENING cantrol Treaty D direct ofs. seg. 11-12 hrs wak Erhs. form ofs say. 3-4 hrs. work for (Enter) rams (10 mg) = Ohi talling indiv. 200 hrs including interview May wb. , 145,000 100 hr. interesting zoo 700 Too his enduring 145/1400 220 9663 madewrole you 1975 Houston Ayes 77042 assessment 100 Do 100 (no Othing) hr, evel ating system rend 40 hr. cottony data direct ofs . 12 S 246 960 less An analysis and description of the program as a whole will be made from an anthropological perspective. The main objective of this portion of the study is to document the planning of the transitional program and to trace its evolution over time as new participant populations are included, staffing arrangements change, and as the program content is refined. Fairweather's study of the evoluation of a community=based program for ex-mental patients is perhaps the best prototype of the type of study that is planned (1969). During the course of the project Fairweather continuously documented the expected outcomes of various planning decisions. He then used on-going experience in the project to test the accuracy of these predictions. Two major types of data will be used in this portion of the study. The first is factual information about how time is spent in the project. This information will be provided by the system measures discussed above, by staff diaries to be completed daily by professional staff members in a simple standardized minutes recording format, and by minutes of meetings with staff members and with outside agencies to be mainbanded by the project director. The second type of data includes perceptions and assessments made by various staff members about the program. An evluation form will be completed monthly by staff members. It will be based on the Community-Oriented Program Evaluation Scale (COPES) developed by Roos et al in their study of psychiatric treatment settings (1974). The evaluation form will focus on individual assessments of the various program elements, on relationships among staff and among participants, on interaction between parti- cipnats and the active handicapped community resource persons, on managerial and decision making processes, on the social atmosphere, and on areas that are seen as problems by the staff members. In addition to these types of data, the project director will continuausly record observations in the form of anthro- pological field notes. These observations will be focused on areas such as staff relationships and on roles within the project. They will include explicit statements of expectations expressed by staff members in various planning meetings. lex MOITATIJIS 051 dibay The transitional graut was been formally approved. Descrie thinks it will be funcle visept. l telled with Ed about Dich santo Mon. evening and to invite whomever also scott Bigham be thought would be interested Jean 960 leh. ffs 210 shows mailing 300 interview 20 anylan 320h 200 not. or 640 9 5-2 2 3 it's O, Ox O2 XR O3 Ox known treatments & goals X13 Teaching learning XR "sehal" (whole person) measures X1-3 specific losts of knowledge are shall XR mometor attitudinal and behavioral change Xx3 pretest-portest control designs groups w treatment presentation XR that multi method measures methods [wahg selectuble] X102 103 simple tax ass. w module XR - attitude semantic differential interview 560 inventory - behavior (undtensive) archives acerectory - odometers books dants money April counters observations sociogram function vilists interview system mg design monitor, organize file transformation evaluation feedback [unintended offects/good free unknown treatments efficts request more Enstant and comp whensive observation daily interviews typtanic collection Direct observation diaries Control Group ? expensive involves design of was collection of deta evide feedback 11/2 hr. of direct off requires 11-12 hr. work 1/2 hr. of form obs requires 3 hr. work 3 Primary cologocias of masorement designed and 1-3 be obtiel tabs changes caused g the unbrown tracticals 3 unintended effects 9 brown longtom effects of Veprogram Silver green known Switton goal, Z effect of DAOC intraction I Ducture year voi widep yest self Merity is concept intiatric students of activity InDuate set criteria rankom Control group BDA interview Di Eddismond form D1 Flage D-8 Bah. Ee diary suplems meas, any transpo up services class attendant colorages problem Dometon meal module efams general BA Fister Grand/spt scale BA Seler genatic AYAP 2f lex- This is the stuff from esrael Gordiamond that Baubara wanted to look at iii formulating a proposed resident-kept record. & thought you might want a copy too Jean The University of Chicago Taber 2 but widle Rev. Mar. 74 Department of Psychiatry Or. Feb. 70 I. CONSTRUCTIONAL QUESTIONNAIRE (The purpose of these questions is to obtain information, hence their wording is to be tailored to the occasion.) (INTRODUCTION) I am going to ask some questions to help us both understand what it is that we should work toward. The questions have three purposes: First, we'll need information to help acquaint us with you. Second, from the questions people ask, you can learn things about them, so this should help you learn about our approach. Third, to see how we're progressing, we need records, and befores and afters. This is a kind of before on how you see things now, and what aims you want now, SO please speak up. (QUESTION 1: OUTCOMES) I am going to ask you a group of questions about our goals. You are here because you want certain changes to occur, or want something else. (a. Presented outcome) The first of these is: Assuming we were successful, what would the outcome be for you? (b. Observable outcome) Now, this may sound silly, but suppose one of these flying saucers is for real. It lands and 2,000 little Martians pour out. One of them is assigned to observe you -- your name was chosen by their computer on some random basis. He lands some time after L-Day -- Liberation Day from your problems -- and follows you around invisibly. He records his observations and these are put on IBM (Interplanetary Business of Mars) cards. Their computer will decide on the basis of the sample of 2,000 Earthlings they have, what their disposition toward Earth should be. What does he observe? (b. Alternate or added form: What would others observe when the successful outcome was obtained?) (c. Present state) How does this differ from the present state of affairs? (d. Example) Can you give nie an example? (QUESTION 2: AREAS CHANGED, UNCHANGED) The next group concerns things in your life which are going well, and things which are not. (a. Areas unchanged) What's going well for you now, and what areas of your life would not be affected by our program? (b. By-products) What areas other than those we'd directly work on would change? (QUESTION 3: CHANGE HISTORY) This next series concerns your efforts to change things. (a. Present attempt) Why start now? How come? (b. First attempt) When did it first occur to you to try to change? What was going on? What did you do? How did it come out? (c. Intervening attempts) What did you do then? What was going on? How did it come out? (Series continues until present). (QUESTION 4: ASSETS) The next series is concerned with the strengths and skills you have that we can build on. No one starts out from scratch. (a. Related skills) What skills or strengths do you have which are related to what you'd like to program? (b. Other skills) What others do you have? (c. Stimulus control) Are there conditions when the present problem is not a problem? (d. Relevant problem-solving repertoire) In the past, what related problems did you tackle successfully? What related programs did you succeed in? How? (e. Other problems solved) What other problems did you tackle successfully? How? (f. Past control) Did you once have mastery of the present problem area? If so, when, and under what circumstances? Any idea of how? (QUESTION 5: CONSEQUENCES) I am going to ask some questions about effects produced, and effects you'd like to produce. (a. Symptom reinforcer: positive) You've heard of the proverb, "It is an ill-wind that blows no good.' With regard to some advantages that might have "blown your way," has your problem ever produced any special advantages or considerations for you? (Examples: in school, job, at home) please give specific examples. (b. Symptom reinforcer: negative) As a result of your problem, have you been excused for things -- or from things -- that you might not be otherwise? (c. Symptom cost) How is your present problem a drag, or how does it jeopardize you? (Note: Omit if answered in 3a. Why start now?) (d. Possible current reinforcers) What do you really like to do, or would like to do? Is there anything that really sends you? (e. High probability behaviors) What do you find yourself doing instead? (or getting instead?) (f. Social reinforcers) Who else is interested in the changes you're after? (g. Past social reinforcers) What people have been helpful in the past? How did they go about it? How did you obtain this from them? (QUESTION 6: COMPLETION) Is there anything we left out or didn't get enough about? Was there something we overlooked - - or made too much of? Are there any impressions you'd like to correct? (QUESTION 7: TURNABOUT) Turnabout is fair play. We have asked you a lot of questions. Are there any questions you'd like to ask of us? Any comments? Kicks? Any- thing you'd like to know about our goals, or approach? The University of Chicago Analysis of Behavior Constructional Development Program Department of Psychiatry PROGRAM CONTRACT ONE: ASSESSMENT PART ONE: Purpose Two program contracts will be signed. The purpose of this statement is to explain the first one. The first program contract deals with the arrangements necessary for us to find out how we can best help you attain your goals. We obtain this information in two ways. One way is the initial inter- view we have been engaged in. The other has yet to be done. It concerns the way things are going now outside the office. This information can only be obtained from direct observation, either by us, or by you. For this purpose records are required. Professionals collect data in addition to histories and purposes for coming. For example, the physician collects "resting" measures or basal measures. These records include temperature, pulse rate, blood pressure, basal metabolism, X-ray, as well as other tests. If you want to learn something, the educator may require aptitude and achievement scores. The architect may want to know your living requirements. Very often, the physician does not initiate his treatment immediately. Nor does the educator immediately plunge you into the course. They wait to see what the data will tell them. The physician may also want data on your situation outside the office before treatment starts. The educator may want to see how you do in temporary classes before assigning you to your regular class. The architect may want to visit you in your present home. In our program, we require at least two weeks, or two assessment sessions before we start the program. These are called baselines. Some- times, it may take longer, but we hope to start as soon as possible. After we are satisfied that we know enough to make our assessment and plans, we shall supply you with our analysis and recommendations. Please note the following: these will be recommendations which we shall offer for your approval. If you have other opinions, you can then say SO. Whatever comes out will be by mutual agreement. Otherwise, there is no point in either of us agreeing to go ahead: We may, however, agree to continue to explore further possibilities, if this is mutually agreeable. Or either or both of us may decide to go no further. Whenever we have obtained mutual agreement regarding the outcomes, programs, and requirements, we shall present a second program contract. If for some reason we decide that continuation will not help you or us, we shall terminate. We need your consent to get the information necessary for assessment. This first program contract is for this assessment period. The University of Chicago Analysis of Behavior Department of Psychiatry Constructional Development Program PROGRAM CONTRACT ONE: ASSESSMENT - DIAGNOSIS PART TWO: General Arrangements IN ORDER FOR US TO ASSESS PROGRAM OUTCOMES, PROGRAM PROCEDURES AND PROGRAM REQUIREMENTS, A. On your part you agree that B. On our part we agree that with regard to with regard to 1. APPOINTMENTS, You will attend sessions set up. We shall keep appointments If you find it impossible to set up. If we can not meet attend, please notify us on a them, we shall try to in- business day not less than form you at least three 24 hours. in advance. Time and days in advance, barring place are in Part Three, emergencies. specific arrangements. 2. RECORDS, You will try to keep the records We shall explain the purpose we assign as well as you can, of the records, the entries, and will bring them to sessions. and analyze and provide feed- Types of baseline records are in back on how well you are Part Three. keeping them. 3. OTHER ASSIGNMENTS, You will try to fulfill various We shall similarly explain other specified assignments, as purpose of assignments and made. provide feedback on your performance. 4. OTHER CONSULTATIONS, You will, if requested, consult We shall explain the with other professionals or rationale involved, and concerned parties. Nature of where necessary, make or consultation is indicated in suggest arrangements. Part Three. 5. OTHER RECORDS, You consent, if requested, to We shall similarly explain authorize examination of other the rationale involved. records, to be indicated in Part Three. The University of Chicago Analysis of Behavior Department of Psychiatry Constructional Development Program 6. RESEARCH, TRAINING, AND CONFIDENTIALITY, (Data from your records can by We shall preserve the confi- useful for consultation with dentiality of your records other staff members, training and take every precaution of staff, and research pub- to insure that any data dis- lications which help other seminated are not identified professionals and thereby with you, in accord with other clients. ) You consent prevailing practice with to the use of such data for medical and psychiatric these purposes, with re- records and research. Any strictions noted in Part other type of dissemination Three. is specified in Part Three. 7. REGULAR AND SPECIAL FEES, You consent to payment of fees We shall provide the con- described in Part Three, both ditions and personnel for regular sessions and for necessary for assessment, special purposes described. and shall explain the special fees involved. 8. STAFFING, You will work with whatever We shall try to adhere to staff are agreed upon. staffing arrangements made. 9. DISPOSITION, You understand that upon We shall report to you the evaluation, we can consider results of our assessment the outcomes to be attained, and the disposition we the program procedures and recommend. requirements necessary, to be of such a nature as to make it unprofitable for you or for us to continue. THE University 01 Citicago Analysis of Behavior Department of Psychiatry Constructional Development Program PROGRAM CONTRACT ONE: ASSESSMENT - DIAGNOSIS PART THREE: Specific Arrangements 1. Appointments: 2. Baseline records: Time: Place: 3. Other assignments: 4. Initial consultation required: 5. Other records required: 6. Research and training needs: Dissemination consented to for each: a. Tapes of sessions Video: Audio: b. Other tapes: C. Baseline records: : i : d. Other assignments: e. Other records: f. Programmer notes: Write ups: g. Special agreements: I Audience 1. GD General Dissemination 5. TR Trainees Key 2. GS General Sessions 6. CS Clinic staff 3. SS Scientific Journals, 7. PG Program staff Sessions only 4. HS Hospital staff 8. CC Case con- sultants The University of Chicago Analysis of Behavior Department of Psychiatry Constructional Development Program 7. Fees Amount: Per: Payable to: When Other: Regular Special 8. Staffing agreed upon: Baseline: Thereafter: 9. Consent does not imply continuation beyond assessment, or before, if 'terms unmet, or for other reasons. I agree to the foregoing: I agree to the foregoing: Client(s) Programmer (s) Monitor(s) Date: Date: The University of Chicago Rev. Mar. 74 Department of Psychiatry II. CASE PRESENTATION GUIDE A. Introduction 1. Identifying information. Brief description of patient and a few qualifying statements which are relevant to what follows. 2. Background for the program. Use A3 as the resolution toward which this presentation is directed. Weave in various items from questionnaire and other sources to present a coherent picture of a person functioning highly competently, given his circumstances and implicit or explicit goals, and personal and social history. Infer how symptom may have been shaped and its functional history. 3. Symptom as costly operant. Infer how, as a result of A2, the patterns shaped and reinforced up to now are now too costly or otherwise jeopardizing the patient. Infer what reinforcers are presently maintaining patterns, sources, and type of jeopardy and its source. This should be brief and simply stated as the logical outgrowth from A2, which presented in somewhat more detail what led up to this. B. Tentative program directions. 1. Outcomes which seem reasonable as targets 2. Evidence for each of these a. Relation to reinforcers maintaining symptom b. Likelihood of producing additional reinforcers. C. Feasibility of substitution for jeopardizing symptom d. Relation to present repertoires i. Personal ii. Environmental and available. 3. Feasibility (cost, resources) C. Current relevant repertoires 1. General, for program-recording requirements: a. Analytical, types of relations explained b. Recording repertoires 2. For each of targets recommended: a, Previous programs b. Current relevant repertoires: assay of current resources C. Social repertoires d. Environmental assets e. Maintaining and available consequences; accessibility. Symptom as reinforcement indicator. D. Change procedures: programing guides 1. For program-recording and analysis of each target a. Analytic procedures to be used (texts, manual, , discussions) b. Records to be kept; graphs. 2. For target areas a. Programs and repertoires in past to be transfered or modeled. How? b. Shaping, modeling, or transfer procedures for changing present repertoires C. Getting and shaping program cooperation from others; reinforcing such cooperation d. Ways current environmental resources might be used. Facilities. Possible social models e. Social and other possible support. Analysis of symptom as successful operant. E. Maintenance guides 1. Through program a. Records, graphs, other assignments b. Other possibilities C. Reliability checks d. Extraneous consequences 2. Thereafter F. Specific programs 1. Available specific programs 2. Staffing 3. Other suggestions