Developing a social problem solving program with the input of adults with intellectual disabilities and their staff

Individuals with intellectual disabilities (IWIDs) are moving from family homes due to the aging and deaths of family caregivers. Residential care in small group homes increased by >300% over 20 years. Already high rates of aggressive/challenging behaviors among IWIDs (45-60%) are exacerbated in residential care. Consequences include emergency room visits, hospitalizations, more restrictive environments, and incarceration. Reducing aggressive/challenging behaviors is important for promoting the health and well-being of this vulnerable population and in supporting caregivers. Social problem-solving (SPS) programs have shown success, but have not been delivered within the natural support system of the group home. The purpose of our work was to modify an existing research-based SPS program Attitude, Define, Alternatives, Predict and Tryout (ADAPT) for the group home environment. Input was sought from supervisory staff responsible for behavior programs for IWIDs, IWIDs, and residential staff. Using versions of ADAPT meant for professional staff and lay populations and previous experience among IWIDs, an initial modification of ADAPT was developed. An Advisory Council of supervisory staff provided many suggestions. Cognitive interviews were conducted separately with IWIDs and residential staff, with a cross-case analysis matrix for analysis. Following the interviews, the focus of our manual was changed to being for IWIDs and residential staff rather than for facilitators and many other changes were made. The next step is to pilot the program (now called ADAPT-M) in group homes to test feasibility and preliminary efficacy. The process and results of partnering with this vulnerable group to develop and pilot ADAPT-M are discussed.