Effectiveness of Everyday Occupations for Changing Client Behaviors in a Community Living Arrangement Margo B. Holm, PhD, OTR/L, FAOTA, ABDA, is Professor, Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania 15260; and Adjunct Professor, Occupational Therapy, College Misericordia, Dallas, Pennsylvania. Maria A. Santangelo, MSOT, OTR/L, is Rehabilitation Equipment Specialist, Chesapeake Rehab Equipment, Upper Darby, Pennsylvania. Donald J. Fromuth, MSOT, OTR/L, is Staff Occupational Therapist, Spruce Manor Nursing and Rehab Center, Reading, Pennsylvania. Sandra O. Brown, MSOT, OTR/L, is Staff Occupational Therapist, Ken Crest Services, Infant/Toddler Community Programs, Philadelphia, Pennsylvania. Heather Walter, MSOT, OT, is Staff Occupational Therapist, United Cerebral Palsy Infant/Toddler Programs, Denver, Colorado. This article was accepted for publication May 12, 1999, under the editor- ship of Editor Emerita, Elaine Viseltear. Margo B. Holm, Maria A. Santangelo, Donald J. Fromuth, Sandra O. Brown, Heather Walter Key Words: child development disorders • planning techniques (programs) • psychiatry The American Journal of Occupational Therapy 361 Objective. This study examined the effect of three occupa- tions-based interventions for reducing the frequency of dys- functional behaviors (disruptive vocalizations, distraction of others, withdrawal from appropriate social interactions) in two women with dual (i.e., developmental, psychiatric) conditions. Additionally, the duration of time spent appro- priately engaged was examined. Method. A single-subject, multiple baseline, across- subjects design, with two dually diagnosed residents in a Community Living Arrangement (CLA), was used to eval- uate change in four behaviors under three alternating con- ditions. Condition 1 was CLA (morning and evening com- bined) compared with the school and sheltered workshop, Condition 2 was CLA morning, and Condition 3 was CLA evening. Intervention consisted of engagement in everyday occupations associated with the school–workshop and CLA settings as well as a positive reinforcement pro- gram. Results. Using occupations-based interventions and a behavior modification program, 5 of 6 behaviors improved significantly in the school-and-workshop setting compared to the CLA, under Condition 1. Under Condition 2, the morning occupations-based intervention in conjunction with positive reinforcement for active participation signifi- cantly improved 4 of 6 behaviors for the two residents. Similarly, under Condition 3—the evening occupations- based intervention—4 of the 6 targeted behaviors improved significantly. Conclusion. The use of everyday occupations as inter- ventions, in conjunction with positive reinforcement for active participation, was effective for decreasing dysfunc- tional behaviors and increasing functional behaviors in two women with dual conditions who resided in a CLA. Holm, M. B., Santangelo, M. A., Fromuth, D. J., Brown, S. O., & Walter, H. (2000). Effectiveness of everyday occupations for changing client behaviors in a community living arrangement. American Journal of Occupational Therapy, 54, 361–371. D einstitutionalization refers to the discharge of per- sons from institutions for the purpose of changing the manner in which treatment is provided. That is, from an institutional base to a community base for the delivery of treatment as well as the use of community sup- port services. “Few controversies in public psychiatry are as important or as notorious as the debate about deinstitu- tionalization” (Okin, 1987, p. 4) or the manner in which and where it should occur (National Institutes of Health, 1989). In 1975, state-run facilities were faced with legisla- tion (Public Law 94-63) to provide the least restrictive set- ting possible. In an attempt to comply with this mandate, community-based programs became more widely available. Community Living Arrangements (CLAs) and Downloaded from http://ajot.aota.org on 05/24/2020 Terms of use: http://AOTA.org/terms