An Intervention to Promote the Health and Wellness of Adults with Developmental Disabilities Living in Supported Arrangements
“The environment where [individuals with mental retardation] live, work, learn, and socialize should offer opportunities to support and reinforce healthy lifestyles.” (U.S. Surgeon General, 2002)
There has been an explosion of interest in the health and wellness of people with disabilities. Recently, this interest has extended to those with intellectual and developmental disabilities. The national agenda for the health of Americans has established objectives for improving the health of this population. Researchers at The University of Montana have been conducting research into the prevention of secondary conditions experienced by people with disabilities since 1988.
The GOAL of this project was to develop, demonstrate, and evaluate the effectiveness of The Wellness Club, a new program designed to promote the health and wellness of adults with developmental disabilities living in supported living arrangements through the prevention and management of secondary conditions.
The Wellness Club was a model program for organizing in-home services and supports to prevent and manage secondary conditions. It was designed to establish and maintain healthy lifestyles using behavioral methods appropriate to the population of adults with developmental disabilities served in supported living arrangements.
The Wellness Club consisted of general health education and materials for providers and consumers, global assessment procedures for individual planning, functional assessments for individual treatment plan design, standard mechanisms for prompting and reinforcing healthy life-style behavior, self-monitoring, and evaluation measures and procedures. We designed the Wellness Club to fit seamlessly into community programs providing supported living services.
This research produced a how-to procedures manual for use by staff operating supported living programs and a manual for use by supervisory staff on how to organize the environment to promote healthy behavior, how to orient new staff, and how to evaluate the effectiveness of their efforts.
The Wellness Club included Computer Assisted Continuous Individual Treatment and Evaluation (CACITE) as an optional program component. This system allowed staff and consumers to review health education information updated on CDs. It also permitted consumers to use the computer to self-monitor their individualized Wellness Club plan
We developed a surveillance and program planning model Behavioral Health Monitoring and Promotion System (BHMPS). In this model, The Wellness Club was embedded into the surveillance system and was the intervention component of the BHMPS. At the local level, service providers conducted health education, screened individuals for areas of concern, assessed health status to determine needs, developed treatment plans, implemented plans, maintained gains, and evaluated progress. The loop was closed when annual surveillance was again conducted.
Designing for Dissemination
The Wellness Club was designed for dissemination to the national network of supported living programs. As such, it was designed to be cost-effective and to fit into the system of rules and regulations regarding treatment and services of adults with developmental disabilities. It was based on behavior modification techniques and procedures that have consistently been shown to be effective and that are widely used as the basis of treatment services in the national network of supported living programs. Further, The Wellness Club relied on resources readily available at the local level and emphasizes structuring the treatment and service environment with minimal emphasis on staff training; thus addressing the staff turn-over problem. Finally, it provided for individual service planning and evaluation.
Detailed Description of the Intervention
“Johnson lost 50 pounds when he moved in. ‘He’s got more activities going (now) than you or I do,’ said his brother. ‘They’re so busy. He just loves that, to get out and about.’” (Ginny Merriam, Missoulian, p. E1, May 4, 2003).
Recently, applied behavior analysis has been shown as an effective strategy for establishing and maintaining healthy behavioral repertoires among the general population (e.g., Green & Kreuter, 1991). Few, if any studies, however, have reported combining behavioral techniques to promoting health, or preventing and managing secondary conditions among adults with developmental disabilities. The Wellness Club provided a system based on behavioral procedures to help adults with developmental disabilities living in supported arrangements prevent and manage secondary conditions.
The Wellness Club was an organized program that engaged consumers of supported living arrangements in a process of managing their health to prevent secondary conditions and maximize their abilities. It was offered in the context of the residence and with the support of personal assistants, direct service staff, and case managers. Consumers who enrolled in The Wellness Club program agreed to work on two or more health objectives and to participate in the structured activities of The Wellness Club, including setting personal goals, providing data, self-monitoring, receiving feedback, and participating in social support meetings
Residential service providers assisted consumers in determining relevant personal goals, developing a program with specific short-term objectives, and support activities designed to achieve the objectives. They provided prompts and reinforcement for targeted health behaviors. Research staff provided orientation to The Wellness Club in both the pilot and study sites, utilizing The Wellness Club Handbook as the text for these instructional sessions. Research staff also provided technical assistance in program development, where appropriate. Finally, research staff also collected data needed for research purposes.
At the local program level, direct service staff screened consumers for important risk factors. This screening led to the development of Individual Health Plan objectives as part of the formal individual plan (IP) of service. Staff designed behavioral programs to achieve consumers’ health objectives. These programs were implemented and evaluated as other such programs in the IP. Finally, the loop was closed when surveillance system data were again collected for the population. This allowed for evaluation of the impact of The Wellness Club and the establishment of new systems priorities.
The Wellness Club was a system designed to increase the probability of healthy behavior through a structured system of reinforcement. The intervention consisted of seven major programmatic components, including: (1) promoting health awareness among consumers and staff, (2) screening for areas of potential health concerns, (3) evaluating individual health status and need, (4) developing individualized Wellness Club plans, (5) implementing individual health plans through programs of prompting and reinforcement for healthy behavior, (6) monitoring health behavior and improvements, and (7) maintaining and evaluating gains. As such, The Wellness Club constituted an evidence-based, health behavior approach to prevent and manage secondary conditions that is compatible with the national system of supported living programs.
Experimental Design and Evaluation
We evaluated The Wellness Club at three levels. First, we evaluated the effectiveness of the specific intervention procedures in establishing and maintaining healthy behavioral repertoires specifically designed to change lifestyle. These included, for example, reinforcement procedures individually tailored to increase levels of physical activity, improve nutritional habits (e.g., achieve and maintain desired weight), improve oral health and personal hygiene, and address emotional health. These evaluations involved single-subject research designs.
Second, we evaluated the effectiveness of life-style changes on health status using three global measures of health. Third, we assessed the social validity of the program through qualitative interviews with participants.
Collaborators and Partners
Researchers from the University of Montana and the University of Kansas worked with two local community service organizations in their communities, Opportunity Resources of Missoula, Montana and Community Living Opportunities of Lawrence, Kansas. In addition, researchers worked with Health Risk Appraisal, Inc to explore the application of HRA within this context. Finally, the project had several advisors in each state, as well as national experts, who provided advice and guidance throughout the course of the project.