Steps to Effective Problem-solving (STEPS) in group homes

Aggressive/challenging behaviors (A/CBs) among individuals with intellectual disabilities (ID) have serious consequences, including psychiatric hospitalizations and incarcerations. Over 400,000 (and increasing) individuals with ID live in small group homes; where 20-25% report distress from other residents' A/CBs. Punitive measures violate human rights; positive behavior supports are encouraged. Individuals with ID are susceptible to A/CBs due to deficits in social problem solving (SPS), the cognitive and behavioral activities used to solve problems. SPS training in clinical settings shows positive results on behaviors; the training needs to be translated to community settings. The group home environment can provide positive behavior support. We previously worked with individuals with ID and residential staff to modify for community settings a SPS program developed by Nezu and colleagues; now called Steps to Effective Problem-solving (STEPS). STEPS (six sessions/one booster) was piloted in two group homes (one male/one female) with a history of A/CBs. 25% of individuals with ID (mean age 36.6 [SD 10.5]) and 50% of residential staff were minorities; Attendance was 70% and 67% and high satisfaction 91% and 87% respectively. The effect size was d=.6 for individuals with ID improved SPS skills and A/CBs, d=.6 for residential staff improved SPS skills; and d=.51 for group-level improved SPS skills. Implementing STEPS in group homes is likely to improve SPS skills of individuals with ID, their residential staff, and the whole group and may decrease A/CBs. STEPS is a potentially sustainable behavior-support program that may empower individuals with ID to reduce A/CBs and their consequences.