Those with intellectual developmental disabilities (IDD) frequently live with

their families for support and care (Freedman & Boyer, 2000). Family caregivers can

be crucial in improving the wellbeing of those under their care, but this can be at a

cost to their own mental and physical health, as family members become clients

(Heller, Gibbons, & Fisher, 2015). This is especially important as caregiver’s feelings

of control then reflect onto those they are caring for, affecting their wellbeing

(Freedman & Boyer, 2000).

An IDD individual can often face distinct difficulties with self-control and anger,

but IDD is often co-morbid with mental disorders (King, et al., 1999; Fuller &

Sabatino, 1998). This co-morbidity can trigger inappropriate behavior while in the

community. Their acting out over time can contribute to their being removed from a

good situation with their family to be placed in residential treatment (Fuller &

Sabatino, 1998). To this end, it is important that those individuals with IDD have the

skills necessary to display appropriate behavior in public. It also eases the burden

on caregivers, since they are able to bring their family member/client into public

without anxiety.

Additionally, those with IDD are living longer, but with more age-related health

problems than the rest of the population (Heller, Gibbons, & Fisher, 2015). As a

result the need for support for both caregivers and clients is already significant and

is growing. The topic of the group therefore, will be ameliorating the stresses of care

giving and teaching skills of appropriate public behavior to caregivers and their

clients. The larger approach will be that of psycho-educational counseling, as this

method is useful for helping families manage difficult situations (Van Hook, 2016).
 Those with Intellectual Developmental Disabilities often face difficulty with

employment and are commonly under the care of either a parent or an agency

(Heller, Gibbons, & Fisher, 2015). As a result those with IDD can have starkly limited

choices, which can create feelings of frustration and helplessness. While Existential

Therapy is a possibility for this, since it allows for a greater sense of choice,

Cognitive Behavioral Therapy (CBT) addresses these feelings, while at the same

time helping to modify maladaptive behaviors (Corey, Corey, & Corey, 2014).

Integrating existential therapy concepts into psycho-educational and CBT

approaches seems the most apt.

The session would end with a discussion of what the exercises have brought up

for the clients and caregivers.

Goals

Behavioral skills will need to incorporate a psycho-educational approach, This

method is to support caregivers in maintaining progress made by those in their care.

Design

The group will by necessity have to remain open, as caregiver’s schedules can be

hectic and because the program would most likely be offered in tandem with other

programs, like day programs, who receive new clients that it would be improper to

refuse. Corey, Corey, and Corey (2014) note that this lack of choice is common, but

that it requires greater engagement by the therapist.

 We know that the caregiver’s state affects the client, but it is only logical that the

reverse is true. Therefore, clients and caregivers should ideally come together for

sessions. This will work to the caregiver’s advantage, as finding someone to watch

the client presents a difficulty.

Screening

A simple method for finding participants would be to offer this service in

connection to a day program that serves IDD adults. These allow the clients a place

to go on weekdays when their caregiver is at work or needs relief. In my experience,

these programs are often looking for additional programs and would provide a

facility in which to have the sessions. Family members would also find this

convenient, as they would be going to the facility to pick up their family

member/client. There are other programs that serve similar functions as these day

programs, which one’s organization could partner with to similar effect.

The age of the participants needs to be that of adults, since the evidence for the

proposal is largely based on adult studies. Beyond this limit, there needs to be a

lower limit of the functioning level of the client, as even the role-playing necessitates

basic verbal skills. This is necessary as the group thrives by working with both

caregivers and clients together to support each other. A common way to give the

spectrum of a developmental disability is mild, moderate, or severe and profound,

with severe and profound being those who are non-verbal. Those of moderate or

above, and their caregivers, would be appropriate for group. I have looked for an
appropriate screening tool, but there doesn’t seem to be one appropriate for the

wide range of IDD. It may come down to common sense as to who is appropriate.

Format

The first three months of sessions will adjust the time given to Cognitive

Behavioral Therapy (CBT) exercises and psycho-educational work, as well as the

beginning and ending checks. For now, a rough guideline is given, which will need to

be adjusted to the needs of the group:

Any session will begin with an overview of confidentiality and the rules of

engagement for the session, followed by a psychoeducational subject for the session,

a CBT skills practice, and a wrap up at the end. Rules of engagement will be about

focus and respect, since distractions and discursive talk are a common part of group

programs with IDD populations (Longhurst, Richards, Copenhaver, & Morrow,

2010). An overly distracting client or caregiver may be asked to take a brief break

from group and only be dismissed if the disruption continues over several sessions.

We will go around the room at this point and have all individuals discuss briefly

their goals and progress. This will allow for assessment, but more importantly here

it will allow for new members to orient themselves to the point of the group.

Exercises

Psycho-educational therapy is appropriate for the IDD population when it

supports their caretakers (Marwood & Hewitt, 2012). Psychoeducational therapy

works to support the family as a whole as well. The therapist will focus on practical

issues around topics relevant to the group for this portion. For instance, A therapist

may discuss issues of socialization for those on the autism spectrum and how to
ease anxiety around this. This will also allow the therapists to introduce new

techniques and subjects to use within the context of CBT in the next portion of the

session.

Part of psychoeducational therapy is resource coordination (Van Hook, 2014).

Connection to financial resources is vital, given the limitations faced by caregivers.

Getting them resources early can help to prevent a crisis (Freedman & Boyer, 2000).

CBT has been shown to have an effect on maladaptive behaviors in IDD

populations, but needs modification in terms of its implementation to be effective

(King, et al., 1999; Marwood & Hewitt, 2012). Specifically, CBT requires a lot of

representational thinking, which can be a challenge for clients with IDD. For that

reason, role play and practicing interactions is an effective way to implement CBT

for IDD adults (Marwood & Hewitt, 2012). This worked well when clients had

someone they knew to use the techniques on, so it is very appropriate for the group.

The Marwood and Hewitt study (2012) also showed that CBT could be paired with

psycho-educational therapy to some effect.

At the end of the session we will reconvene to discuss what issues arose during

the session. This will also be the opportunity to set goals, which the therapist will

try to direct towards the Guidelines of S.MA.R.T: Specific, Measurable, Attainable,

Realistic, and Timely (Kamph, 2012). For instance, a goal that “Jacky will start

spending her money better” might become “Jacky will save $10 of what she earns by

next therapy session.”

Assessment
 Since a crucial part of the group from the outset is integrating those with IDD

into the community by teaching them socially appropriate behavior, success will be

measured in terms of successful outings into said community and by parameters set

in-group based on practical considerations. An example might be Johnny will attend

a welcome table once a week, during which time he will not steal food from others,

leave the building without telling others, or have an angry outburst. Doing so will

enhance Johnny’s wellbeing by getting out into the community, but success will help

to ease a caregiver’s reluctance to take Johnny to public gatherings. Similarly a

failure would be measured by which behaviors were the difficulty and addressed in

future sessions.

Caregivers will be given a Quality of Life Scale on their entering the group and

again at the eight-week marker (Cummins, 1995; Marwood & Hewitt, 2012).