Modifying Programs: Staying Focused on the Primary Domain

Modifying Programs: Staying Focused on the Primary Domain

When residents are experiencing limited success in a program, it is our job to modify our approach, and perhaps the program, to meet them where they are (see the previous post called “Person-Centered Programming – Meeting Residents Where They Are”). We do this to ensure the residents are having a positive, rewarding, and successful program experience.

We sometimes see recreationists lose focus on the intended expected outcome however, when they start modifying their approach in order to provide the resident with a successful outcome.

For example, let’s look at everyone’s favorite program – BINGO (a resident favorite, and perhaps the program you feel like skipping every so often – but you always run without fail- and with enthusiasm!!!). The first aspect we need to agree on is the primary domain of the activity. BINGO is NOT social – it is an anti-social group activity! BINGO is primarily an intellectual program involving the matching of numbers and letters into specific patterns.

One resident who comes to BINGO is struggling to find the numbers on the cards. The recreationist has slowed down the calling of numbers to give the resident a greater chance, but if the process is slowed down too much, other residents start to complain about the slow pace.

Stop for a moment and ask yourself if you are calling BINGO in a “normal” way.

  • Are you repeating the call of the letter and number three times, like they do in a BINGO hall?
  • Are you using a PA system so everyone can hear, like in a BINGO hall?
  • Are you posting the numbers as you call them (on a flip chart of whiteboard) so people can see them, like they do in a BINGO hall?

These are normal approaches to playing BINGO that help to overcome non-cognitive challenges – such as auditory and visual impairments, that may also be helpful for the person who is moderately confused. In other words, repetition helps everyone, without slowing the game down for those who are challenged as a result of some intellectual limitations.

The use of larger print cards are another good adaptation relative to helping those with visual impairments or limitations. And while you are at it, if you search a little harder, when you buy your next set of BINGO cards, look for a set in which the numbers in every column are in ascending order! So instead of a listing of numbers under the “B” as 14, 3, 11, 9 and 6, the column would read 3, 6, 9, 11, and 14. This format makes it much easier to find the numbers for everyone, and your “expert” residents will probably not even notice!

But what about our resident who still can’t keep up finding the numbers, because the game is still too challenging for her or him?

We often hear people say the way they modify the activity is to engage a volunteer who “helps” the resident with the activity. When we ask how do they do this, the answer is the volunteer helps by pointing to the number on the card. If the primary purpose of the program is intellectual stimulation, then we have to ask “Who is being intellectually engaged at this point?” The answer is the volunteer, with the resident simply covering the number. It is no longer an intellectual domain program.

Here is a suggestion we learned many years ago from an experienced recreationist who understood the purpose of the program, and devised a simple, but effective way to modify the program such that the resident had a greater chance of success in the intellectual domain.

The volunteer holds two pieces of paper, and when the letter and number are called, they simply block the other four columns, so the resident has to only scan down one column to look for the number. BINGO! A simplification of the program! Instead of searching through five columns containing five numbers or squares, the resident’s field of vision is reduced to one column of five squares.

Program modification is an important aspect of good programming. It is essential that you maintain your focus on the primary domain of the program when you incorporate changes to accommodate varying degrees of resident abilities. Take a few moments to watch your residents and think about your expected outcomes, and then look for ways to adjust your approach and in turn, your expectations of success for the resident.