Irina Paraschiv, Ph.D. and J. Gregory Olley, Ph.D.
As the self-determination and self-advocacy movements have grown, professionals and disability advocacy groups have found a need for services to support these movements. The notion of self-determination is now a key-concept in the provision of services. Wehmeyer, Kelchner, and Richards (1996) defined self-determination as the sum of abilities and attitudes required to act as the primary causal agent in ones life and to make the choices regarding ones quality of life free from undue external influence or interference.
Most definitions of self-determination include the following three basic requirements: (a) knowledge and skills on the part of the individual; (b) positive attitudes towards taking control over ones life, including self-knowledge, self-confidence, and self-actualization; and (c) opportunities to act in a self-determined way. All three of these elements must exist for self-determination to be possible. In this article, we will concentrate on certain aspects of the skills and knowledge needed to be self-determined.
Many skills are important for adaptive community living, including initiative, development and awareness of preferences, choice/decision making, personal goal setting, problem solving, independent thinking, assertiveness, self-advocacy, self-regulation, self-efficacy, and persistence. However, to develop these skills people with disabilities require programs adapted to their individual learning, motivational, and emotional characteristics. For example, instructional programs should include active participation, emotional support, multiple opportunities to experience success, and a flexible format to permit generalization of the learned skills.
Rationale and Purpose of the Program
Problem Solving for Life is an instructional program that addresses various skills for successful community integration, but most importantly, teaches the participants to use the repertoire of skills they already possess. People with developmental disabilities and mental health difficulties often have problems in securing and maintaining jobs, making friends, and getting along with others in the workplace and at home. However, these problems are often due less to a lack of skills than to the failure to use those skills when the situation asks for them. To illustrate how problem situations may lead to negative outcomes, we will provide an example inspired by a real situation.
Jake went, as usual, to his supported employment site where he worked as a janitor. He started to prepare the equipment needed for his job when he noticed that his bucket was not in its usual place, next to the vacuum cleaner. He stared at the empty space, and a sudden panic overcame him. He could think of nothing, as if his mind went blank. The only thing that passed though his mind was that he could not do his work. As he sat there, he felt a mounting fear that his boss and his job coach would criticize him and he would lose his job. He started crying as he sat down on a nearby chair. Luckily, the job coach came by before the store manager could see Jake just sitting on the job. The job coach helped Jake find an adaptive solution to the problem.
The example described above is typical of many situations in which individuals with disabilities are overwhelmed by emotions and do not make use of the skills they possess. If Jake had mastered a problem solving strategy, he could have used it with or without the prompts of another person, and found a suitable solution.
What is a Problem?
A problem occurs when there is a discrepancy between the persons current state and the goal state (Ferretti & Cavalier, 1991). These authors pointed out that a problem occurs in a space resulting from the interaction between the goal to be achieved and the persons internal representation of the task environment (the surrounding circumstances). Social problems can be defined as life situations (concrete or anticipated) that require effective coping responses to overcome barriers, such as ambiguity, uncertainty, novelty, emotional distress, and/or conflicting demands (Nezu & Nezu, 1991). The problem situation is a result of the interaction between the person and his or her environment and reflects the imbalance among the persons needs, desires, and goals, the environments characteristics, and the availability of an adaptive response. In this formulation, the term environment includes both the physical and social factors encountered (i.e., the properties of the physical space and the behavior of the other person(s) present in the social space).
A solution to a social problem can be defined as an adaptive coping response that is directed toward overcoming the barriers between the person and the accomplishment of his/her goals. The solution also has the effect of altering the persons negative emotional reactions to the encountered problem. In practice, solutions can have either or both of the results listed above. Similarly, DZurilla and Nezu (1980) pointed out that effective solutions achieve the desired results and simultaneously maximize other positive consequences (benefits) and minimize other negative consequences (costs).
Early studies assumed that problem solving ability is linked to academic performance and requires substantial cognitive skills and knowledge. From this viewpoint, people with mental retardation would have very limited potential for learning to solve problems. However, recent studies and programs on social skills development have examined problems that arise in social contexts and involve interpersonal relationships. Social problem solving can be defined as the process by which people both understand and react to problems in daily living. Spivack, Platt and Shure (1976) distinguished between impersonal, intellectual problem-solving abilities and interpersonal problem-solving skills, suggesting that different processes take place in different problem-solving contexts. Although these different processes have not been clearly identified, interpersonal problem solving skills may be thought of as a form of social intelligence. Such abilities may ensure high social competence, but they have not been found to correlate very highly with IQ scores. Therefore, social skills in general and the problem solving approach to social problems in particular can be effectively taught to persons with lower functioning levels than originally anticipated.
Social problems are complex and can have multiple solutions. In addition, other social skills (such as appreciation of feelings in ones self and in others and perspective taking) play a part in the solution of social problems. The Problem Solving for Life program addresses the social problem solving process in a format that is suited to the learning style of individuals with mental retardation and related disorders.
The Problem Solving for Life training program, developed at the Clinical Center for the Study of Development and Learning, University of North Carolina at Chapel Hill, has been designed to teach problem solving skills to adolescents and adults with a variety of disabilities. The program is described in a detailed manual that provides step-by-step instructions to carry out the 34 sessions of the program. 1 This training program follows the well-established and effective methods for teaching problem solving, while it adds several modifications to accommodate instruction for individuals with more severe learning and emotional difficulties. These modifications are described below.
Group participants are taught to solve problems by practicing two prerequisite skills, relaxation and positive self-statements, and four basic steps of problem solving: (a) identification/definition of the problem, (b) identification of alternative solutions, (c) choice of the best solution, and (d) implementation. Problem Solving for Life retains the well-known principles of problem solving but reduces and simplifies the steps. Thus, participants with moderate or severe mental retardation should be able to learn at least the first two steps (relaxation and positive self-statements). In contrast to other programs of this type, the participants are not required to anticipate and evaluate the possible positive and negative consequences of each solution, because:
1. Many individuals with moderate and severe mental retardation have limited verbal abilities and are not able to express their thoughts with ease.
2. More severely impaired individuals have a restricted capacity to anticipate future events and to imagine possible occurrences that may result from a certain action.
3. Experience with similar groups has shown that, even if they cannot anticipate and analyze the consequences of different solutions, they are nevertheless able to choose a reasonable solution (Fuchs & Benson, 1995.)
For these reasons, Problem Solving for Life eliminated the process of anticipating and evaluating the consequences of possible solutions, making it simpler and more appropriate for individuals with more severe disorders. The program is a combination of two fundamental approaches to problem solving skills training: teaching the process and teaching the content of problem solving. It incorporates the following basic principles and concepts:
1.Group participation and role playing with minimal language requirements
2.Active learning and participation
3.Understanding emotions, their causes, and consequences
4.Learning relaxation as a prerequisite for problem solving
6.Repetition of sequences to ensure overlearning and establishment of a routine
7.Individualized instruction while participating in group activities
Interviews with staff members from vocational and mental health centers, adult education programs, and other service agencies identified many problems common to individuals with disabilities in community living. These problems are the basis for instructional role-plays. The most common categories of problems included (a) asking for information, help, or favors from others; (b) refusing unreasonable requests; (c) dealing with legitimate criticism; and (d) handling disagreements, meeting new people, and coping with objectionable behavior from others.
Program Implementation and Results
The Problem Solving for Life program has been implemented by various agencies in the state of North Carolina and in other states. Pilot studies monitored its implementation in agencies offering services to adults with developmental disabilities, such as Compensatory Education and Vocational Rehabilitation programs. Later, mental health and residential service providers included problem solving in their services for individuals with other disabilities, such as autism and dual diagnoses of mental retardation and mental illness. Recently, we have piloted the program in high school transition services for youngsters with mental retardation and other disabilities. The transition and special services/exceptional children coordinators have seen a fit between problem solving and career preparation or life skills curricula. The personnel implementing problem solving at various agencies have provided valuable suggestions for adaptations to the program to fit the characteristics of specific populations.
Research data on the effectiveness of the program come from a controlled study on adults with mental retardation. The results show that all participants gained valuable social skills, even though the most low-functioning participants did not master all of the skills in the training program2 .
Participants showed gains in one or more of the following areas:
1.Assertiveness skills (expressed by confident body posture, tone of voice, gaze, and eye contact, expression of feelings and opinions, etc.)
2.Problem solving skills: Although not all participants were able to remember the whole problem solving sequence, most participants learned the first one or two steps (i.e., to relax and say a positive statement to yourself), which in most cases is enough to prevent impulsive maladaptive behavior.
3.Recognition of emotions. Participants gained an increased awareness of the wide range of emotions experienced in various situations and of the ways powerful emotions can lead to unwanted behavior.
Research on the effectiveness of Problem Solving for Life is continuing in several sites. Research findings and anecdotal information to date suggest that it is an effective and practical approach to teaching many social skills. These include simple skills, such as giving and receiving compliments, and complex skills, such as applying strategies and sequences of actions to deal with unexpected events. Presently, the Learning for Life staff at the Center for Development and Learning is conducting research on the effectiveness of this program for adults and adolescents with dual diagnoses and for high school students with various disabilities preparing for transition to community living.
DZurrilla. T. J., & Nezu, A. (1980). A study of the generation-of-alternatives process in social problem solving. Cognitive Therapy and Research, 4, 67-72.
Ferretti, R. P., & Cavalier, A. R. (1991). Constraints on the problem solving of persons with mental retardation. International Review of Research in Mental retardation, 17, 153-192.
Fuchs, C., & Benson, B. A. (1995) Social information processing by aggressive and nonaggressive men with mental retardation. American Journal on Mental Retardation, 100, 244-252.
Nezu, C. M., & Nezu, A. M. (1991). Assertiveness and problem solving training for mildly mentally retarded persons with dual diagnoses. Research in Developmental Disabilities, 12, 371-386.
Spivack, G. S., Platt, J.J., & Shure, M. B. (1976). The problem-solving approach to adjustment. Jossey-Bass: San Francisco.
Wehmeyer, M. L., Kelchner, K., & Richards, S. (1996) Essential characteristics of self-determined behavior of individuals with mental retardation. American Journal on Mental Retardation, 100, 632-642.
1 The Problem Solving for Life manual and accompanying audiotape, currently in their draft form, are available to be piloted by interested agencies or institutions. For more information visit http://cdl.unch.unc.edu/lfl/ or contact Irina Paraschiv, Ph.D. Learning for Life Project Coordinator, Clinical Center for the Study of Development and Learning, University of North Carolina, Chapel Hill, NC 27599-7255. Email: firstname.lastname@example.org
2 For those interested in the results of the statistical analyses, you can request a copy of the research findings on adults with mental retardation from Irina Paraschiv, Learning for Life Project Coordinator, Clinical Center for the Study of Development and Learning, University of North Carolina, Chapel Hill, NC 27599-7255. Email: email@example.com
For further information contact:
Irina Paraschiv, Ph.D. and J. Gregory Olley, Ph.D.
Center for Development and Learning
University of North Carolina at Chapel Hill
CB # 7255
Chapel Hill, NC 27599-7255