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Interinstitutional misadventures in a training program for parents of retarded children: Who gets caught in the middle?
Analysis and Intervention in DevelopmentalDisabilities,Vol. 3, pp. 239-248, 1983 Printedin the USA. All rights reserved.
0270-4684/83 $3.00 + .00 Copyright © 1983 PergamonPress Ltd
Interinstitutional Misadventures in a Training Program for Parents of Retarded Children" Who Gets Caught in the Middle? Tom Ball, R. Michael larvis, and Stephen S. F. Pease Fairview State Hospital
Textbook accounts of a logical, linear evolution of program development will not prepare one for the rough and tumble realities of bureaucratic politics. Even when offered a much-needed, free service mental health bureacracies may treat your "gift" warily. To the outsider, this reaction often appears to be a perverse contradiction of self-interest. Yet, perceptions of bureaucratic self-interest may have less to do with specific humanitarian values and the cultivation of good will than with the symbols and trappings of power. Our story recapitulates our attempts to implement a thoroughly field-tested course for parents of retarded children in the face of bureaucratic hurdles. From such experiences one learns to respect some of Machiavelli's insights without necessarily surrendering to his cynicism.
We do not endorse the attitude of opportunism and cynical manipulation associated with the name of Machiavelli. We concede, however, that our own experiences conform quite well to what that 16th century statesman had to say about the combination of luck and preparation that are the ingredients of success in social organizations. PROJECT HISTORY In July of 1979 the senior author was directing a facility-wide behavior modification team at Fairview State Hospital. There were six of us. We provided in-service training to facility staff and did intensive interventions with clients Address reprint requests to Dr. T. Ball, Staff Psychologist, Fairview State Hospital, Costa Mesa, C A 92626
239
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presenting especially difficult behavior problems. The team had first been established at Fairview some 10 years previously by people originally trained by a federally funded, behavior modification training project the senior author had directed at Pacific State Hospital from 1968 to 1970. We were pleased by the effectiveness of the operation and the fact that hospital personnel appreciated and respected our efforts. We enjoyed a shared sense of adventure, a comraderie that develops between people who push the limits of their capacities and often succeed. Content with what we were doing, we had no intention of becoming involved in a community-based behavioral training program for parents of developmentally disabled children. Our sense of complacency regarding our mission was unexpectedly shattered by a memo from our headquarters Department of Developmental Services 500 miles away in Sacramento. The Hospital Operations Division directed us to implement a 24-hour per day, 7-day per week behavioral crisis intervention program "to hopefully prevent (re) hospitalizations by assisting the regional center, family, or caretaker in modifying or designing an 'in situ' program for the client." This program, which was oriented toward clients who performed "serious acts of damage or injury to property or others," was to become "operational" by midnight Sunday, July 1st, 1979, which was 1 week before the memorandum arrived! We were to accomplish all of this with no additional resources. Implementation of this model would have hamstrung our intramural program at the hospital. Preventive intervention through parent training occurring before the crisis stage was more to our liking. It seemed potentially more cost-effective and to offer a chance of salvaging at least part of our traditional functions. We quickly formulated a counterproposal that deflected the emphasis on crisis intervention and argued for a preventive model of parent training. The response was a phone call from Dr. Allan Toedter, Chief, Office of Cooperative Service System Affairs, Department of Developmental Services. Dr. Toedter, who was famili~ with our work, was departmental liaison with the State Council of Developmental Disabilities, a state grant-funding agency. He said that the Director of the Department of Developmental Services, Dr. David Loberg, liked the proposal. History affects the sociopolitics of institutional change, for Dr. Loberg had taken our behavior modification training course at Pacific State Hospital in 1968. They suggested that we immediately prepare a grant application. Cathy Joy and Richard Otto, of the behavior mod team, generated a detailed proposal, which was approved for funding. We also received approval from Fairview's Executive Director, Dr. Frank Crinella, to divert existing resources to the project and even acquire additional staff, pending receipt of state funding.
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FIRST LESSONS IN INTERAGENCY POLITICS California's regional centers are state-funded, private agencies which serve as clearinghouses for services to developmentally disabled people. It was through the regional center that we initially sought to advertise our program and generate referrals. In September, 1979, we contacted the local regional center. Its director responded to our announcement with unqualified enthusiasm. He wrote, "What a terrific project!... It will be a boon to parents and greeted with hosannas by my staff. We will be asked to participate, won't we?" Subsequently, we found that his assistant director did not share his enthusiasm. Unfortunately, it was to her that he delegated most of the authority for dealing with the project staff. A pattern of chronic conflict with the Assistant Director soon began to emerge. For example, she required that both parents and careproviders (who were attending the course on their own time) pay for use of the regional center's parking lot during class attendance. This policy was later reversed when I appealed directly to the center's director. But in the context of the whole situation it was a minor victory. We were faced with a host of additional annoyances, both petty and major, including restrictions on the use of the key to a room where they kept their video equipment. And on nights when a capacious and air conditioned conference room sat empty we were denied its use and relegated to an unventilated basement room. Because of the summer heat we had to keep the door open and speak over the noise of janitorial activities in the adjacent hallway. Finally, when I appealed to the assistant director about these circumstances, she informed me that if I didn't like the situation we could go elsewhere. She treated us as if the regional center were doing us a favor. In reality, we were providing, at no cost to either the regional center or parents, a program that filled a notable gap in the services offered to the parents of developmentally disabled individuals in Orange County. Furthermore, it was a highly successful operation that provided them with free publicity. In fairness, it should be pointed out that the Regional Center eventually provided temporary funding for two project staff members during a hiatus in their eligibility for appointments as hospital employees. Yet even this move failed to offset the generally negative influence of the assistant director and a few other key staff. CURRICULUM AND STAFF By September of 1979 we were evaluating parent training curricula and visiting training centers throughout the southern California area. From Dr. Michael Ogle of the Tri-Counties Regional Center in Santa Barbara, we obtained some very useful videotapes. Earlier experiences in running large scale communitybased parent training classes provided valuable pointers (Weathers & Liberman,
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T. Ball, R.M. Jarvis, and S. Pease
1978). We chose as the centerpiece of our project the parent training curriculum developed by Baker and his colleagues (Baker et al, 1979). Later, as a consultant, Baker and Duncan Clark, both of UCLA, provided a comprehensive orientation to their program. This excellent curriculum has been a major factor in our program's success. We have also been favored with highly qualified staff. We inherited the intramural behavior modification team. This group of highly trained individuals provided the bulk of the personnel originally devoted to the training of care providers. The remainder of the staff was made up of two extremely wellqualified master's degree level women who were unemployed wives of other hospital staff, and two current hospital staff members. One of the latter was on limited duty and the other unwanted by his previous supervisor. T H E INTRODUCTION OF PARENT ASSISTANTS AS VOLUNTEERS The decision to recruit parent training graduates to assist us in training other parents was inspired, in part, by California's notorious anti-tax Proposition 13. We predicted that its long-term impact would be decreased state funding for human services. Also, we hoped that incorporating volunteerism into a new proposal might be sufficiently innovative and timely to earn us a second year's funding. We were inspired by Ora's (1976) report, in which parents assumed a major role in running an entire program for handicapped' pre-school children. Yet in reviewing the literature we found a notable lack of detail regarding the problems and limitations encountered in developing parents as trainers of other parents. This informational gap afforded us the opportunity to make a potentially publishable contribution to the field. Furthermore, we were involved in a collaborative research project with Dr. Baker who sought to have his parent training package independently evaluated by an agency outside the university. These systematically compiled behavioral data could be employed for our own purposes; that is, to evaluate the possible impact of parent graduate assistants on various outcome measures obtained from parents taking the class for the first time. Three graduates of our course were selected using the following criteria: 1) they scored 90% or higher on a multiple choice test on the application of behavior modification principles; 2) they had a successful outcome on their behavior modification interventions with their own developmentally disabled child; and 3) they were verbal and articulate during class discussions. All were mothers and homemakers with 16, 14, and 13 years of education, respectively. All agreed to participate on a volunteer basis and accepted travel reimbursement when it was offered to them. Reimbursement was not offered to subsequent volunteers. Professional staff met with the volunteers for at least 31/2 hours each week. The training program consisted of four components; reading and study questions,
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designing and implementing interventions, trouble shooting and assisting with ongoing classes. In addition to attending the weekly training meetings, volunteers assisted one evening per week with current classes for newly-involved parents. However, their performance fell short of our expectations. We had intended for them to become increasingly autonomous of professional staff participation. For example, they were to have been initially trained to assist with the role plays and to make short presentations on simple topics such as backward chaining. Later, they were to have carried out role-plays independently and made presentations on more complex topics such as forced compliance. During the training meetings, the volunteers rehearsed the lectures, role-plays, or activities that they would be conducting in class that week. At the end of this training period, we concluded that no volunteer was sufficiently competent to conduct classes independently of the professional staff. Parent assistants were deficient in three areas. First, their knowledge of the principles was inadequate. Most volunteers consistently made errors when presenting topics and answering questions. Second, their troubleshooting skills were poor. Frequently, they did not control the direction of the consultation. Time was spent on topics that were irrelevant or unproductive with conversation centering around what the student rather than the trainer wanted to talk about. Also, they did not recognize when a behavior problem presented by a student was of a complex or severe nature. They erroneously treated these problems as simple issues thereby providing inappropriate advice. Finally, their experiential background in applying the principles was inadequate. The volunteers had conducted a limited number of interventions with their own children. Their skill and knowledge in applying the principles was narrow. In addition, they tended to rely on the methods they had used with their own children when troubleshooting o r answering questions. Often, these methods were not relevant or appropriate to the issue at hand. Our major concern was that these deficits were serious and not easily remediated. Although all the volunteers demonstrated an increase in expertise, a considerable amount of professional time was needed to bring them to their current levels and a considerable amount of additional time would be needed to produce trainers who could function independently. The model was proving inefficient, costly, and, at times, counterproductive. Aside from the time spent training the volunteers, there was another significant cost. Volunteers were frequently contacting us for consultation regarding their own children and families. It appeared that this free consultation and attention from professionals was a major reinforcer for their participating in the project. Inadvertently, our consultation became a form of payment for the large amount of time the volunteers were donating to the project. For these reasons, we made two major modifications to the model. First, we
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decided to train volunteers as teaching assistants rather than preparing them to teach independently of the professionals. Second, we contacted local community colleges whose extension programs were willing to offer formal course credit for our nine-week volunteer training course that met weekly for 21/2 hours. This course was taught by our own staff, without remuneration, in a convenient off campus setting. College credit, rather than free consultation from professionals, became an incentive to volunteers. Also, the college format was time limited with specific requirements for course credit. This structure placed our relationship with volunteers on a more business-like basis. It established staff in a better defined and more effective supervisory role. Logistical difficulties led the project to abandon the group training format for the parent trainers. As a result, the trainers were taught on a tutorial basis while continuing to use the same advanced curriculum. Actually, this had led to a further decrease in the time required of project staff. Another modification was the shift in emphasis in the project's utilization of the parent trainers. The main change involved their level of participation in troubleshooting and developing intervention strategies. Although some of these issues were discussed in the small groups, we asked the trainers to encourage discussion among the parents to give them practice with independently troubleshooting the teaching programs. However, we asked the volunteers to be supportive but nonjudgmental in evoking discussion of alternative approaches to the problem at hand. The volunteers would then summarize the results of their discussion group for the entire class. At this point the professional evaluated the seriousness and complexity of the problem the parents were raising. If the problem seemed in the realm of the trainer's expertise, the professional deferred to the trainer to lead the discussion. If the professional perceived that the problem was too complex for the volunteer or if the volunteer seemed about to flounder, the professional threw the problem open to a large group discussion. The professional guided the troubleshooting discussion toward an appropriate resolution by redirection of inappropriate suggestions and lavish praise of appropriate comments. This reinforced the students who could then generalize the principles they had learned. DECENTRALIZATION OF THE TRAINING PROGRAM Originally, the Regional Center agreed to assume full responsibility for case finding and recruiting both parents and care providers. This system worked relatively well for the first two cycles of classes. They provided about 24 parents and 10 care providers for our first four classes. At that point, the referral system began to. break down. We showed up for our third cycle of classes with the assurance that they would be filled. However, no one was there! We went back to the drawing board. On examining the situation, it was clear that the regional
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center's referral system was haphazard, at best. We quickly assessed that we would have to step into the breach and began calling the parents, whom the regional center claimed to have referred, to promote our classes. Most of them said they did not know who we were or only had a vague recollection of our being mentioned somewhere in a long list of possible options for services countywide. Clearly, this referral arrangement was not satisfactory. From that time forward, we have insisted on having a standardized one-page information sheet on each referral mailed to us. We then notified the parent that the referral had been made, explained who we were, and told them when to expect the next class. Subsequently, we called to confirm their continuing interest and give specific times, dates and location. In the long run our frustrations over their haphazard referral system and our negative interactions with the assistant director had a positive result; that is, they accelerated our efforts toward decentralization. This is the point at which we began exploring affiliations with special education schools in the community. We sent out flyers pinned to the lapels of students in a couple of schools. These produced a few phone calls for classes at those respective schools. Satisfied parents began spreading the word about how helpful our classes had been. We began getting calls from various school personnel including physical therapists, nurses, psychologists, and principals. These personnel were interested to see the positive changes that had taken place in some of their more recalcitrant parents. The schools' professional personnel reacted enthusiastically when they found out that the service was not only available to them but would be free! So far, 6 schools have participated. They have provided us with extraordinary support for 10 classes. And several schools are still awaiting our services. Thus, our real support network turned out to be volunteers and students. Having benefited themselves, they encouraged us to continue the project and maintain a high quality teaching program. Our best referrals came from former students who eventually began referring entire schools. On her own, one parent purchased a blank videotape so that she could make a copy of her pre- and post-training tapes to show at a faculty meeting at her daughter's school. The faculty was so impressed with the progress made by a child they had experienced as very recalcitrant, that the school psychologist called us to ask if we would train him to teach the parents in his school. We gladly agreed. Some parents have gone so far as to arrange space and equipment for us at various schools. For the most part, these collaborations with the schools have been infinitely more productive than our attempts to achieve cooperation with the regional center. Through such experiences the parents helped us to see that the future of the project did not lie in our originally conceived close ties with the regional center. It was not until after we had achieved decentralization that our relationship with the regional center changed. In September, 1980 we informed the regional center leadership, in effect, "Don't call us. We'll call you." Over the next 6
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months parents referred by the regional center were not given priority for placement in our classes. Preference was given to parents referred by local schools participating in our program. At this juncture a concerned psychologist on the regional center staff stepped forward to offer herself as the liaison person instead of the Assistant Director, who was obviously not being cooperative. We readily agreed and she negotiated the change in the line of referral at the regional center. Since this switch took place, relations with that particular referral source have become much more cordial. The drawback is that we continue to run into administrative sabotage that might have been averted had we won over our original contact person. Since she retained control of classroom space, this has remained a problem. But it was one that could be ignored since practically all of our classes were, by then, taught in other locations.
CURRENT STATUS OF TRAINING PROGRAM Our request for a second year of funding through the Developmental Disabilities Council was denied. Another event, one with far-reaching effects on morale, was the decision by Fairview's executive director to abolish the behavior modification team and assign the positions elsewhere. This cut a wide swath through the staff available for training. Fortunately, at about the same time the state mandated behavior modification training., through community colleges, for all care providers as a prerequisite for licensure and reimbursement. In its heyday the program had twelve training staff and two clerical assistants. The project director, the senior author, resigned in January of 1981 to assume duties in one of the internal programs at Fairview State Hospital. As of January 1983, two full-time staff remain. They work without secretarial help. That there is any program at all is partly a matter of luck. One trainer is an individual with a great deal of hands-on experience in residential settings. He was assigned as a "gift" to the program when, due to a knee injury, he was placed on limited duty and could no longer be assigned to a hospital unit. The other trainer is a psychologist. He too was a "gift" assigned to us from another intramural program which was gradually being phased out by the present hospital administration. Despite his having achieved his doctorate after joining the project, he remains in the psychometrist position to which he was originally assigned. As soon as there is an opening for a psychologist in one of the hospital's internal programs, he will probably leave the project. Ironically, now that staffing is at its lowest point, the demand for our services has never been greater. In terms of the regional center referrals, our initial rate was about 4 or 5 per month. By the fall of 1980, this meager flow was reduced by our decentralization efforts. Currently, referrals have rebounded significantly and run about 40 per month. This upswing is probably due, at least in part, to
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California's Proposition 13, which led to severe curtailment of the regional center's budget. This had the effect of restricting the behavioral treatment options which the regional center staff could offer parents, thereby making our free program all the more attractive. These referrals are supplemented by about 20 to 30 per month that we receive from participating schools and by word-ofmouth. That the two remaining positions have been spared by Fairview's administration can probably be attributed to the positive reputation the program has earned in the community. Especially helpful is the fact that several graduates have expressed their praise for the program in written testimonials directed to Fairview's executive director. CONCLUSION A proposal for a 24-hour crisis intervention by another California State Hospital was perfectly timed with respect to the interests of the state Department of Developmental Services and the Developmental Disabilities Council. It inspired Sacramento to issue the directive to establish like programs at all state hospitals for the developmentally disabled. Our counterproposal for a preventive parenttraining program was not made with funding in mind. Rather, we hoped to preserve the basic functional format of an intramural behavior modification team. On its way to becoming a funded project, our program piggybacked on the mood of the time and was aided by our positive reputation in Sacramento. Today's buzz-word is tomorrow's cliche. The Fairview behavior modification team, which survived a decade, no longer exsits. The clinical training team at Camarillo State Hospital, described in another article in this issue (Flanagan et al., 1983), has become another victim of funding cutbacks prompted by Proposition 13. That team endured for 10 years, also starting with grant support and ending with dispersal of team members to internal Hospital programs. Thus it is that funding and support are often based largely on zeitgeist and ever-changing priorities. The professional must develop political astuteness and promotional skills. During lean times, he or she must keep faith in the integrity and basic principles of professional practice.
Acknowledgements--The authors wish to express their appreciation to the State Council of Developmental Disabilities, the Department of Developmental Services and Dr. Frank Crinella for their support of this project.
REFERENCES Baker, B. L., Brightman, A. J., Heifetz, L. J. and Murphy, D. M. Steps to independence. Champaign, IL: Research Press, 1979.
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T. Ball, R.M. Jarvis, and S. Pease
Ora, J. P. A parent implemented early intervention program for preschool children. Hospital & Community Psychiatry, 1976, 27, 728-731. Weathers, L., and Liberman, R. P. Modification of family behavior. In D. Marholin (Ed.) Child Behavior Therapy, New York: Gardner Press, 1978, pp. 150-186.
0270-4684/83 $3.00 + .00 Copyright © 1983 PergamonPress Ltd
Interinstitutional Misadventures in a Training Program for Parents of Retarded Children" Who Gets Caught in the Middle? Tom Ball, R. Michael larvis, and Stephen S. F. Pease Fairview State Hospital
Textbook accounts of a logical, linear evolution of program development will not prepare one for the rough and tumble realities of bureaucratic politics. Even when offered a much-needed, free service mental health bureacracies may treat your "gift" warily. To the outsider, this reaction often appears to be a perverse contradiction of self-interest. Yet, perceptions of bureaucratic self-interest may have less to do with specific humanitarian values and the cultivation of good will than with the symbols and trappings of power. Our story recapitulates our attempts to implement a thoroughly field-tested course for parents of retarded children in the face of bureaucratic hurdles. From such experiences one learns to respect some of Machiavelli's insights without necessarily surrendering to his cynicism.
We do not endorse the attitude of opportunism and cynical manipulation associated with the name of Machiavelli. We concede, however, that our own experiences conform quite well to what that 16th century statesman had to say about the combination of luck and preparation that are the ingredients of success in social organizations. PROJECT HISTORY In July of 1979 the senior author was directing a facility-wide behavior modification team at Fairview State Hospital. There were six of us. We provided in-service training to facility staff and did intensive interventions with clients Address reprint requests to Dr. T. Ball, Staff Psychologist, Fairview State Hospital, Costa Mesa, C A 92626
239
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T. Ball, R.M. Jarvis, and S. Pease
presenting especially difficult behavior problems. The team had first been established at Fairview some 10 years previously by people originally trained by a federally funded, behavior modification training project the senior author had directed at Pacific State Hospital from 1968 to 1970. We were pleased by the effectiveness of the operation and the fact that hospital personnel appreciated and respected our efforts. We enjoyed a shared sense of adventure, a comraderie that develops between people who push the limits of their capacities and often succeed. Content with what we were doing, we had no intention of becoming involved in a community-based behavioral training program for parents of developmentally disabled children. Our sense of complacency regarding our mission was unexpectedly shattered by a memo from our headquarters Department of Developmental Services 500 miles away in Sacramento. The Hospital Operations Division directed us to implement a 24-hour per day, 7-day per week behavioral crisis intervention program "to hopefully prevent (re) hospitalizations by assisting the regional center, family, or caretaker in modifying or designing an 'in situ' program for the client." This program, which was oriented toward clients who performed "serious acts of damage or injury to property or others," was to become "operational" by midnight Sunday, July 1st, 1979, which was 1 week before the memorandum arrived! We were to accomplish all of this with no additional resources. Implementation of this model would have hamstrung our intramural program at the hospital. Preventive intervention through parent training occurring before the crisis stage was more to our liking. It seemed potentially more cost-effective and to offer a chance of salvaging at least part of our traditional functions. We quickly formulated a counterproposal that deflected the emphasis on crisis intervention and argued for a preventive model of parent training. The response was a phone call from Dr. Allan Toedter, Chief, Office of Cooperative Service System Affairs, Department of Developmental Services. Dr. Toedter, who was famili~ with our work, was departmental liaison with the State Council of Developmental Disabilities, a state grant-funding agency. He said that the Director of the Department of Developmental Services, Dr. David Loberg, liked the proposal. History affects the sociopolitics of institutional change, for Dr. Loberg had taken our behavior modification training course at Pacific State Hospital in 1968. They suggested that we immediately prepare a grant application. Cathy Joy and Richard Otto, of the behavior mod team, generated a detailed proposal, which was approved for funding. We also received approval from Fairview's Executive Director, Dr. Frank Crinella, to divert existing resources to the project and even acquire additional staff, pending receipt of state funding.
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FIRST LESSONS IN INTERAGENCY POLITICS California's regional centers are state-funded, private agencies which serve as clearinghouses for services to developmentally disabled people. It was through the regional center that we initially sought to advertise our program and generate referrals. In September, 1979, we contacted the local regional center. Its director responded to our announcement with unqualified enthusiasm. He wrote, "What a terrific project!... It will be a boon to parents and greeted with hosannas by my staff. We will be asked to participate, won't we?" Subsequently, we found that his assistant director did not share his enthusiasm. Unfortunately, it was to her that he delegated most of the authority for dealing with the project staff. A pattern of chronic conflict with the Assistant Director soon began to emerge. For example, she required that both parents and careproviders (who were attending the course on their own time) pay for use of the regional center's parking lot during class attendance. This policy was later reversed when I appealed directly to the center's director. But in the context of the whole situation it was a minor victory. We were faced with a host of additional annoyances, both petty and major, including restrictions on the use of the key to a room where they kept their video equipment. And on nights when a capacious and air conditioned conference room sat empty we were denied its use and relegated to an unventilated basement room. Because of the summer heat we had to keep the door open and speak over the noise of janitorial activities in the adjacent hallway. Finally, when I appealed to the assistant director about these circumstances, she informed me that if I didn't like the situation we could go elsewhere. She treated us as if the regional center were doing us a favor. In reality, we were providing, at no cost to either the regional center or parents, a program that filled a notable gap in the services offered to the parents of developmentally disabled individuals in Orange County. Furthermore, it was a highly successful operation that provided them with free publicity. In fairness, it should be pointed out that the Regional Center eventually provided temporary funding for two project staff members during a hiatus in their eligibility for appointments as hospital employees. Yet even this move failed to offset the generally negative influence of the assistant director and a few other key staff. CURRICULUM AND STAFF By September of 1979 we were evaluating parent training curricula and visiting training centers throughout the southern California area. From Dr. Michael Ogle of the Tri-Counties Regional Center in Santa Barbara, we obtained some very useful videotapes. Earlier experiences in running large scale communitybased parent training classes provided valuable pointers (Weathers & Liberman,
242
T. Ball, R.M. Jarvis, and S. Pease
1978). We chose as the centerpiece of our project the parent training curriculum developed by Baker and his colleagues (Baker et al, 1979). Later, as a consultant, Baker and Duncan Clark, both of UCLA, provided a comprehensive orientation to their program. This excellent curriculum has been a major factor in our program's success. We have also been favored with highly qualified staff. We inherited the intramural behavior modification team. This group of highly trained individuals provided the bulk of the personnel originally devoted to the training of care providers. The remainder of the staff was made up of two extremely wellqualified master's degree level women who were unemployed wives of other hospital staff, and two current hospital staff members. One of the latter was on limited duty and the other unwanted by his previous supervisor. T H E INTRODUCTION OF PARENT ASSISTANTS AS VOLUNTEERS The decision to recruit parent training graduates to assist us in training other parents was inspired, in part, by California's notorious anti-tax Proposition 13. We predicted that its long-term impact would be decreased state funding for human services. Also, we hoped that incorporating volunteerism into a new proposal might be sufficiently innovative and timely to earn us a second year's funding. We were inspired by Ora's (1976) report, in which parents assumed a major role in running an entire program for handicapped' pre-school children. Yet in reviewing the literature we found a notable lack of detail regarding the problems and limitations encountered in developing parents as trainers of other parents. This informational gap afforded us the opportunity to make a potentially publishable contribution to the field. Furthermore, we were involved in a collaborative research project with Dr. Baker who sought to have his parent training package independently evaluated by an agency outside the university. These systematically compiled behavioral data could be employed for our own purposes; that is, to evaluate the possible impact of parent graduate assistants on various outcome measures obtained from parents taking the class for the first time. Three graduates of our course were selected using the following criteria: 1) they scored 90% or higher on a multiple choice test on the application of behavior modification principles; 2) they had a successful outcome on their behavior modification interventions with their own developmentally disabled child; and 3) they were verbal and articulate during class discussions. All were mothers and homemakers with 16, 14, and 13 years of education, respectively. All agreed to participate on a volunteer basis and accepted travel reimbursement when it was offered to them. Reimbursement was not offered to subsequent volunteers. Professional staff met with the volunteers for at least 31/2 hours each week. The training program consisted of four components; reading and study questions,
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designing and implementing interventions, trouble shooting and assisting with ongoing classes. In addition to attending the weekly training meetings, volunteers assisted one evening per week with current classes for newly-involved parents. However, their performance fell short of our expectations. We had intended for them to become increasingly autonomous of professional staff participation. For example, they were to have been initially trained to assist with the role plays and to make short presentations on simple topics such as backward chaining. Later, they were to have carried out role-plays independently and made presentations on more complex topics such as forced compliance. During the training meetings, the volunteers rehearsed the lectures, role-plays, or activities that they would be conducting in class that week. At the end of this training period, we concluded that no volunteer was sufficiently competent to conduct classes independently of the professional staff. Parent assistants were deficient in three areas. First, their knowledge of the principles was inadequate. Most volunteers consistently made errors when presenting topics and answering questions. Second, their troubleshooting skills were poor. Frequently, they did not control the direction of the consultation. Time was spent on topics that were irrelevant or unproductive with conversation centering around what the student rather than the trainer wanted to talk about. Also, they did not recognize when a behavior problem presented by a student was of a complex or severe nature. They erroneously treated these problems as simple issues thereby providing inappropriate advice. Finally, their experiential background in applying the principles was inadequate. The volunteers had conducted a limited number of interventions with their own children. Their skill and knowledge in applying the principles was narrow. In addition, they tended to rely on the methods they had used with their own children when troubleshooting o r answering questions. Often, these methods were not relevant or appropriate to the issue at hand. Our major concern was that these deficits were serious and not easily remediated. Although all the volunteers demonstrated an increase in expertise, a considerable amount of professional time was needed to bring them to their current levels and a considerable amount of additional time would be needed to produce trainers who could function independently. The model was proving inefficient, costly, and, at times, counterproductive. Aside from the time spent training the volunteers, there was another significant cost. Volunteers were frequently contacting us for consultation regarding their own children and families. It appeared that this free consultation and attention from professionals was a major reinforcer for their participating in the project. Inadvertently, our consultation became a form of payment for the large amount of time the volunteers were donating to the project. For these reasons, we made two major modifications to the model. First, we
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decided to train volunteers as teaching assistants rather than preparing them to teach independently of the professionals. Second, we contacted local community colleges whose extension programs were willing to offer formal course credit for our nine-week volunteer training course that met weekly for 21/2 hours. This course was taught by our own staff, without remuneration, in a convenient off campus setting. College credit, rather than free consultation from professionals, became an incentive to volunteers. Also, the college format was time limited with specific requirements for course credit. This structure placed our relationship with volunteers on a more business-like basis. It established staff in a better defined and more effective supervisory role. Logistical difficulties led the project to abandon the group training format for the parent trainers. As a result, the trainers were taught on a tutorial basis while continuing to use the same advanced curriculum. Actually, this had led to a further decrease in the time required of project staff. Another modification was the shift in emphasis in the project's utilization of the parent trainers. The main change involved their level of participation in troubleshooting and developing intervention strategies. Although some of these issues were discussed in the small groups, we asked the trainers to encourage discussion among the parents to give them practice with independently troubleshooting the teaching programs. However, we asked the volunteers to be supportive but nonjudgmental in evoking discussion of alternative approaches to the problem at hand. The volunteers would then summarize the results of their discussion group for the entire class. At this point the professional evaluated the seriousness and complexity of the problem the parents were raising. If the problem seemed in the realm of the trainer's expertise, the professional deferred to the trainer to lead the discussion. If the professional perceived that the problem was too complex for the volunteer or if the volunteer seemed about to flounder, the professional threw the problem open to a large group discussion. The professional guided the troubleshooting discussion toward an appropriate resolution by redirection of inappropriate suggestions and lavish praise of appropriate comments. This reinforced the students who could then generalize the principles they had learned. DECENTRALIZATION OF THE TRAINING PROGRAM Originally, the Regional Center agreed to assume full responsibility for case finding and recruiting both parents and care providers. This system worked relatively well for the first two cycles of classes. They provided about 24 parents and 10 care providers for our first four classes. At that point, the referral system began to. break down. We showed up for our third cycle of classes with the assurance that they would be filled. However, no one was there! We went back to the drawing board. On examining the situation, it was clear that the regional
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center's referral system was haphazard, at best. We quickly assessed that we would have to step into the breach and began calling the parents, whom the regional center claimed to have referred, to promote our classes. Most of them said they did not know who we were or only had a vague recollection of our being mentioned somewhere in a long list of possible options for services countywide. Clearly, this referral arrangement was not satisfactory. From that time forward, we have insisted on having a standardized one-page information sheet on each referral mailed to us. We then notified the parent that the referral had been made, explained who we were, and told them when to expect the next class. Subsequently, we called to confirm their continuing interest and give specific times, dates and location. In the long run our frustrations over their haphazard referral system and our negative interactions with the assistant director had a positive result; that is, they accelerated our efforts toward decentralization. This is the point at which we began exploring affiliations with special education schools in the community. We sent out flyers pinned to the lapels of students in a couple of schools. These produced a few phone calls for classes at those respective schools. Satisfied parents began spreading the word about how helpful our classes had been. We began getting calls from various school personnel including physical therapists, nurses, psychologists, and principals. These personnel were interested to see the positive changes that had taken place in some of their more recalcitrant parents. The schools' professional personnel reacted enthusiastically when they found out that the service was not only available to them but would be free! So far, 6 schools have participated. They have provided us with extraordinary support for 10 classes. And several schools are still awaiting our services. Thus, our real support network turned out to be volunteers and students. Having benefited themselves, they encouraged us to continue the project and maintain a high quality teaching program. Our best referrals came from former students who eventually began referring entire schools. On her own, one parent purchased a blank videotape so that she could make a copy of her pre- and post-training tapes to show at a faculty meeting at her daughter's school. The faculty was so impressed with the progress made by a child they had experienced as very recalcitrant, that the school psychologist called us to ask if we would train him to teach the parents in his school. We gladly agreed. Some parents have gone so far as to arrange space and equipment for us at various schools. For the most part, these collaborations with the schools have been infinitely more productive than our attempts to achieve cooperation with the regional center. Through such experiences the parents helped us to see that the future of the project did not lie in our originally conceived close ties with the regional center. It was not until after we had achieved decentralization that our relationship with the regional center changed. In September, 1980 we informed the regional center leadership, in effect, "Don't call us. We'll call you." Over the next 6
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months parents referred by the regional center were not given priority for placement in our classes. Preference was given to parents referred by local schools participating in our program. At this juncture a concerned psychologist on the regional center staff stepped forward to offer herself as the liaison person instead of the Assistant Director, who was obviously not being cooperative. We readily agreed and she negotiated the change in the line of referral at the regional center. Since this switch took place, relations with that particular referral source have become much more cordial. The drawback is that we continue to run into administrative sabotage that might have been averted had we won over our original contact person. Since she retained control of classroom space, this has remained a problem. But it was one that could be ignored since practically all of our classes were, by then, taught in other locations.
CURRENT STATUS OF TRAINING PROGRAM Our request for a second year of funding through the Developmental Disabilities Council was denied. Another event, one with far-reaching effects on morale, was the decision by Fairview's executive director to abolish the behavior modification team and assign the positions elsewhere. This cut a wide swath through the staff available for training. Fortunately, at about the same time the state mandated behavior modification training., through community colleges, for all care providers as a prerequisite for licensure and reimbursement. In its heyday the program had twelve training staff and two clerical assistants. The project director, the senior author, resigned in January of 1981 to assume duties in one of the internal programs at Fairview State Hospital. As of January 1983, two full-time staff remain. They work without secretarial help. That there is any program at all is partly a matter of luck. One trainer is an individual with a great deal of hands-on experience in residential settings. He was assigned as a "gift" to the program when, due to a knee injury, he was placed on limited duty and could no longer be assigned to a hospital unit. The other trainer is a psychologist. He too was a "gift" assigned to us from another intramural program which was gradually being phased out by the present hospital administration. Despite his having achieved his doctorate after joining the project, he remains in the psychometrist position to which he was originally assigned. As soon as there is an opening for a psychologist in one of the hospital's internal programs, he will probably leave the project. Ironically, now that staffing is at its lowest point, the demand for our services has never been greater. In terms of the regional center referrals, our initial rate was about 4 or 5 per month. By the fall of 1980, this meager flow was reduced by our decentralization efforts. Currently, referrals have rebounded significantly and run about 40 per month. This upswing is probably due, at least in part, to
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California's Proposition 13, which led to severe curtailment of the regional center's budget. This had the effect of restricting the behavioral treatment options which the regional center staff could offer parents, thereby making our free program all the more attractive. These referrals are supplemented by about 20 to 30 per month that we receive from participating schools and by word-ofmouth. That the two remaining positions have been spared by Fairview's administration can probably be attributed to the positive reputation the program has earned in the community. Especially helpful is the fact that several graduates have expressed their praise for the program in written testimonials directed to Fairview's executive director. CONCLUSION A proposal for a 24-hour crisis intervention by another California State Hospital was perfectly timed with respect to the interests of the state Department of Developmental Services and the Developmental Disabilities Council. It inspired Sacramento to issue the directive to establish like programs at all state hospitals for the developmentally disabled. Our counterproposal for a preventive parenttraining program was not made with funding in mind. Rather, we hoped to preserve the basic functional format of an intramural behavior modification team. On its way to becoming a funded project, our program piggybacked on the mood of the time and was aided by our positive reputation in Sacramento. Today's buzz-word is tomorrow's cliche. The Fairview behavior modification team, which survived a decade, no longer exsits. The clinical training team at Camarillo State Hospital, described in another article in this issue (Flanagan et al., 1983), has become another victim of funding cutbacks prompted by Proposition 13. That team endured for 10 years, also starting with grant support and ending with dispersal of team members to internal Hospital programs. Thus it is that funding and support are often based largely on zeitgeist and ever-changing priorities. The professional must develop political astuteness and promotional skills. During lean times, he or she must keep faith in the integrity and basic principles of professional practice.
Acknowledgements--The authors wish to express their appreciation to the State Council of Developmental Disabilities, the Department of Developmental Services and Dr. Frank Crinella for their support of this project.
REFERENCES Baker, B. L., Brightman, A. J., Heifetz, L. J. and Murphy, D. M. Steps to independence. Champaign, IL: Research Press, 1979.
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Ora, J. P. A parent implemented early intervention program for preschool children. Hospital & Community Psychiatry, 1976, 27, 728-731. Weathers, L., and Liberman, R. P. Modification of family behavior. In D. Marholin (Ed.) Child Behavior Therapy, New York: Gardner Press, 1978, pp. 150-186.