Steps to Effective Problem Solving in Group Homes

Aggressive/challenging behaviors (AC/Bs) are a major public health problem for individuals
with intellectual disabilities (ID) living in group homes. A leading reason for psychiatric
hospitalizations and incarcerations, A/CBs are costly to the healthcare system, agencies and
families. Social problem solving (SPS) training programs for individuals with ID have had
positive behavioral results, but most were conducted in clinical or forensic settings. None
were community-based preventive interventions, none examined whether A/CBs decreased in
participants' group homes and work settings, and none addressed cost effectiveness. In
preliminary work, the investigators modified an effective SPS training program, using input
from individuals with ID and residential staff, as a preventive intervention for the group
home setting. Steps to Effective Problem-solving (STEPS) includes residential staff and uses
the group home environment to facilitate behavior change. The purpose of this clinical trial
is to test the efficacy of STEPS for individuals with ID. Specific aims are to 1) Assess the
efficacy of the STEPS intervention in group homes to improve SPS skills and reduce A/CBs of
the individuals with ID compared to an attention-control nutrition program from baseline to
12, 24 and 36 weeks, controlling for behavioral determinants of A/CBs (demographics,
agency/home environment, current health). 2) Assess the mediating effect of the support
environment for SPS (residential staff SPS skills, group home level SPS skills, and group
cohesiveness) on the improvement of SPS skills and reductions in A/CBs. 3) Evaluate cost
effectiveness of STEPS relative to usual care for A/CB incidents in group homes. The
investigators expect to show STEPS to be a preventive behavioral strategy to reduce A/CBs
among individuals with ID, improve the cost effectiveness of their care and make an important
incremental advance in SPS research.

Inclusion/exclusion criteria

Group home

Inclusion criteria:

- Serve individuals with mild to moderate ID;

- Have at least 10 A/CB incident reports in resident files over the prior six-month
period, with at least 30% of residents in each home having incident reports in that
period

- Have 5 or more residents, with a minimum of 3 agreeing to participate

- Individuals with ID and residential staff all speak English

- Have two residential staff members who agree to participate.

Exclusion criteria:

- If group home specifically serves individuals with ID who also have serious mental
illness (e.g., severe autism, schizophrenia)

- If group home specifically serves forensic populations

- If the group home participated in previous preliminary study

Individual with ID

Inclusion criteria:

- Has mild to moderate ID (operationalized as IQ 50-75 per agency records) and mild to
moderate limitations in adaptive functioning (measured by the Inventory for Client and
Agency Planning used in all residential agencies in Illinois, per agency record)

- Lives in a chosen group home

- Is verbal and speaks English

Exclusion Criteria:

- If individual does not meet inclusion criteria and

- If participated in the preliminary study

Residential staff

Inclusion criteria:

- Employed as residential staff in the chosen group homes and

- Speak and read English

Exclusion criteria:

- Does not meet inclusion criteria

- Participated in the previous preliminary study.